Metabolic Encephalopathy

Question 1

Wernicke/Korsakoff encephalopathy
- patient pop
- triad
-

Answer 1

seen in alcoholics
triad of opthalmoplegia, ataxia, confusion
followed by amnesia

Question 2

what to treat wernickes/Korsakoff

Answer 2

thiamine before glucose

Question 3

wet beriberi

Answer 3

B1 deficiency

-high output cardiac failure

Question 4

dry beriberi

Answer 4

B1 deficiency

• polyneuropathy
• lower limbs afected more than upper limbs
• pain and touch decrease
• loss of akle and knee reflex
• pathology: axonal degeneratiion

Question 5

niacin deficiency

Answer 5

Pellagra

• causes dementia and polyneuropathy
• pathology: diffuse involvement of CNS and PNS neurons

Question 6

Causes of B12 deficiency

Answer 6

pernicious anemia, vegan, celiac sprue, NO abuse

Question 7

areas affected from B12 deficiency

Answer 7

lesions of dorsal columns and lateral corticospinal tract
cerebral white matter, optic nerves, peripheral nerves
WIDESPREAD DEMYELNIATION

Question 8

neuro signs/symptoms of B12 def.

Answer 8

decreased vibration/position sense (+ Romberg)

weakness, distal paresthesias, hyper/hyporeflexia, visual impairment

Question 9

labs for B12 def

Answer 9

low B12
high MMA
high homocysteine

Question 10

Deficiency amblyopia: B complex deficiencies

lesion location

Answer 10

optic nerve, papillomacular bundle

Question 11

Deficiency amblyopia: B complex deficiencies

sxs

Answer 11

decreased visual acuity and blindness

other eye probs

Question 12

Deficiency amblyopia: B complex deficiencies

pathology

Answer 12

loss of myelin/axon

Question 13

Neuro changes in DM (hyperglycemia)

Answer 13

pupillary abnormalities --> opthalmoparesis and diplopia
SMALL PUPILS
decreased reflexes
neurogenic bladder
trophic changes in feet

Question 14

hypoglycemia

Answer 14

dilated pupils
increased reflexes
babinski +
seizures

Question 15

causes of hypoxic encephalopathies

Answer 15

heart problems
CO poison
high altitude sickness
COPD/CO2 poisoning

Question 16

areas of hypoxic encephalopathy

Answer 16

watershed areas
hippocampus
deep folia of cerebellum

Question 17

uremic encephalopathy

Answer 17

similar to hepatic but:
- memory deficits and dementia
- increased tendency for intracranial bleeds
still asterixis
decreased reflexes

Question 18

clinical features of hepatic encephalopathy

Answer 18

flapping tremor
brisk reflexes (differentiates from uremic encephalopathy)