Neurological Syndromes Flashcards
Wernicke’s encephalopathy Normal pressure hydrocephalus Chronic fatigue syndrome Delirium Guillian Barre Syndrome
What is Wernicke’s Encephalopathy?
A neurological disorder caused by thiamine (vitamin B1) deficiency, often associated with alcohol misuse.
True/False: Wernicke’s Encephalopathy only occurs in chronic alcoholics.
False. It can also occur in malnutrition, prolonged vomiting, or after bariatric surgery.
Wernicke’s Encephalopathy is characterized by the classic triad of ______, ______, and ______.
Confusion, ataxia, and ophthalmoplegia.
What is the underlying cause of Wernicke’s Encephalopathy?
Thiamine deficiency leading to impaired glucose metabolism in the brain.
Thiamine is a cofactor for enzymes involved in ______ metabolism.
Glucose
True/False: Wernicke’s Encephalopathy primarily affects the cerebellum.
False. It mainly affects the thalamus, mammillary bodies, and brainstem.
List three key risk factors for Wernicke’s Encephalopathy.
Chronic alcohol misuse, malnutrition, and hyperemesis gravidarum.
True/False: Bariatric surgery is a risk factor for Wernicke’s Encephalopathy.
t
Patients on ______ nutrition are at risk of developing Wernicke’s Encephalopathy if thiamine supplementation is inadequate.
Total parenteral.
What is the classic triad of Wernicke’s Encephalopathy?
Confusion, ataxia, and ophthalmoplegia.
True/False: All patients with Wernicke’s Encephalopathy present with the classic triad.
False. The full triad is present in only about one-third of cases.
In Wernicke’s Encephalopathy, ______ refers to uncoordinated movements and difficulty with balance.
Ataxia
How is Wernicke’s Encephalopathy diagnosed?
Clinically, based on history, risk factors, and symptoms. Imaging may show characteristic changes.
True/False: MRI is the imaging modality of choice for diagnosing Wernicke’s Encephalopathy.
t
MRI findings in Wernicke’s Encephalopathy include hyperintensities in the ______ bodies and periventricular regions.
Mammilary
What is the first-line treatment for Wernicke’s Encephalopathy?
Intravenous thiamine administration.
True/False: Oral thiamine is adequate for initial treatment of Wernicke’s Encephalopathy.
False. Intravenous thiamine is required.
What condition may develop if Wernicke’s Encephalopathy is not treated promptly?
Korsakoff syndrome.
True/False: Symptoms of Wernicke’s Encephalopathy are always reversible with treatment.
False. Delayed treatment can lead to irreversible damage.
Korsakoff syndrome is characterized by severe ______ impairment and confabulation.
Memory
What are the hallmark features of normal pressure hydrocephalus (NPH)?
Memory loss, personality changes, gait disturbances, and urinary incontinence.
How is normal pressure hydrocephalus treated?
With a ventriculoperitoneal shunt, which can lead to recovery if diagnosed early.
What is normal pressure hydrocephalus (NPH)?
A condition characterized by abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles of the brain, causing the classic triad of gait disturbance, cognitive impairment, and urinary incontinence.
The triad of symptoms in NPH includes ______ disturbance, ______ impairment, and urinary ______.
Gait, cognitive, incontinence.
True/False: Normal pressure hydrocephalus always presents with elevated intracranial pressure.
False. The intracranial pressure is usually normal.
What causes normal pressure hydrocephalus?
Impaired resorption of CSF at the arachnoid granulations, leading to ventricular dilation.
In NPH, the ______ ventricles are enlarged, compressing surrounding brain tissue.
Lateral
Describe the typical gait disturbance in NPH.
Magnetic gait: short, shuffling steps with difficulty initiating movement.
True/False: Cognitive impairment in NPH often resembles dementia.
t
The urinary incontinence seen in NPH is often described as ______ incontinence.
Urge
What imaging modality is used to diagnose NPH?
MRI or CT brain showing ventricular enlargement disproportionate to cortical atrophy
A ______ tap test involves removing CSF and assessing for symptom improvement, supporting a diagnosis of NPH.
Lumbar
True/False: Elevated intracranial pressure on lumbar puncture confirms the diagnosis of NPH.
False. The pressure is normal.
What is the mainstay of treatment for NPH?
Ventriculoperitoneal (VP) shunt placement to drain excess CSF.
True/False: Gait disturbance in NPH is the symptom most likely to improve with treatment
t
Patients undergoing shunt placement should be monitored for complications such as ______ or ______.
Infection, over-drainage.
What factors affect the prognosis in NPH?
Early diagnosis and timely treatment are associated with better outcomes.
True/False: Cognitive symptoms of NPH are fully reversible with treatment in all cases.
False. Cognitive symptoms may be less likely to improve.
What is Chronic Fatigue Syndrome (CFS)?
A complex, chronic condition characterized by persistent and disabling fatigue lasting at least 6 months, not alleviated by rest, and often accompanied by other symptoms such as pain, sleep disturbances, and cognitive dysfunction.
True/False: Chronic Fatigue Syndrome is more common in men than women.
False. It is more common in women.
Chronic Fatigue Syndrome is also referred to as ______.
Myalgic Encephalomyelitis (ME).
What are the proposed mechanisms behind Chronic Fatigue Syndrome?
Dysregulation of the immune system, neuroendocrine dysfunction, and central nervous system abnormalities.
Risk factors for Chronic Fatigue Syndrome include a history of ______ illness, stress, and genetic predisposition.
Viral
List some key symptoms of Chronic Fatigue Syndrome
Persistent fatigue.
Post-exertional malaise.
Sleep disturbances.
Cognitive dysfunction (“brain fog”).
Muscle and joint pain.
Headaches.
Dizziness and orthostatic intolerance.
True/False: Fatigue in Chronic Fatigue Syndrome improves with rest.
False. The fatigue is not alleviated by rest.
Cognitive impairment in CFS is often referred to as “______ fog.”
Brain
What is the diagnostic criteria for Chronic Fatigue Syndrome?
Persistent fatigue lasting ≥6 months, not explained by other conditions, with ≥4 of the following: post-exertional malaise, unrefreshing sleep, cognitive impairment, sore throat, tender lymph nodes, muscle pain, joint pain, or headaches.
True/False: Diagnosis of CFS is made primarily by laboratory tests.
False. It is a clinical diagnosis based on exclusion of other conditions.
What investigations are performed to rule out other causes of fatigue in suspected CFS?
Full blood count (FBC).
Thyroid function tests (TFTs).
Serum electrolytes.
Liver function tests (LFTs).
C-reactive protein (CRP).
Vitamin B12 and folate levels.
Glucose testing.
Thyroid function tests help rule out ______ as a differential diagnosis for fatigue.
Hypothyroidism.
What are the main management strategies for CFS?
Symptom management: pain relief, sleep hygiene.
Graded exercise therapy (GET).
Cognitive behavioral therapy (CBT).
Supportive care and education.
True/False: Graded exercise therapy is controversial in managing CFS.
True. It has mixed evidence and can worsen symptoms in some patients
Patients with CFS should be educated to avoid ______-exertion, as this can exacerbate symptoms.
over
What is the prognosis for Chronic Fatigue Syndrome?
Variable; some patients improve over time, but many experience chronic or relapsing symptoms.
True/False: There is currently a cure for Chronic Fatigue Syndrome.
False. There is no cure, but symptoms can be managed.
What is delirium?
Delirium is an acute, fluctuating disturbance of consciousness and cognition, often triggered by an underlying medical condition or external factor.
True/False: Delirium is more common in younger individuals
False. It is more common in older adults.
Delirium is characterized by ______ onset and fluctuating symptoms.
acute
List some risk factors for delirium.
Advanced age.
Cognitive impairment or dementia.
Sensory impairment (e.g., vision or hearing loss).
Severe illness or infection.
Polypharmacy.
Alcohol use or withdrawal.
True/False: Polypharmacy is a significant risk factor for delirium.
t
______ impairment, such as vision or hearing loss, can predispose patients to delirium.
Sensory
What are some common causes of delirium?
Infections (e.g., urinary tract infections, pneumonia).
Medications (e.g., opioids, benzodiazepines).
Dehydration and electrolyte imbalance.
Hypoxia.
Alcohol withdrawal.
Pain and sleep deprivation.
True/False: Hypoxia is a rare cause of delirium.
False. Hypoxia is a common cause.
Common medication-related causes of delirium include ______ and benzodiazepines.
Opiods
What are the clinical features of delirium?
Fluctuating consciousness.
Impaired attention and focus.
Disorientation.
Hallucinations (often visual).
Agitation or lethargy.
Sleep-wake cycle disturbances.
True/False: Hallucinations in delirium are typically auditory.
False. They are often visual.
Sleep-wake cycle disturbances are common in patients with ______.
Delirium.
What are the three types of delirium?
Hyperactive: agitation, restlessness.
Hypoactive: lethargy, reduced responsiveness.
Mixed: fluctuates between hyperactive and hypoactive states.
True/False: Hypoactive delirium is often underdiagnosed.
t
Mixed delirium alternates between ______ and ______ states.
Hyperactive; hypoactive.
What tool is commonly used to diagnose delirium?
The Confusion Assessment Method (CAM).
True/False: CAM includes assessment of acute onset, inattention, disorganized thinking, and altered consciousness.
t
The ______ Assessment Method (CAM) is widely used to diagnose delirium.
Confusion
What are the key steps in managing delirium?
Identify and treat the underlying cause.
Optimize the environment (e.g., lighting, noise reduction).
Provide reassurance and reorientation.
Consider low-dose antipsychotics (e.g., haloperidol) if agitation is severe.
True/False: Benzodiazepines are first-line treatment for delirium.
False. Antipsychotics are used if needed; benzodiazepines are generally avoided unless for alcohol withdrawal.
Management of delirium focuses on identifying and treating the ______ cause.
underlying
What is the prognosis for patients with delirium?
Delirium is reversible if the underlying cause is treated, but it is associated with increased morbidity and mortality, especially in older adults.
True/False: Delirium can cause permanent cognitive decline.
True, in some cases, particularly in those with pre-existing dementia.
Delirium is associated with increased ______ and ______ in older adults.
Morbidity; mortality.
What is Guillain-Barré Syndrome (GBS)?
GBS is an acute, immune-mediated polyneuropathy characterized by ascending muscle weakness and areflexia, often triggered by infections.
True/False: Guillain-Barré Syndrome is caused by direct infection of the peripheral nerves.
False. It is an autoimmune reaction often triggered by infection.
Guillain-Barré Syndrome is mediated by the ______ immune response targeting peripheral nerves.
Autoimmune
Name some common triggers of Guillain-Barré Syndrome.
Campylobacter jejuni infection.
Cytomegalovirus (CMV).
Epstein-Barr virus (EBV).
Influenza virus.
Vaccinations (rare).
True/False: Campylobacter jejuni is the most common trigger of GBS.
t
The most common bacterial trigger of GBS is ______.
Campylobacter jejuni.
Describe the clinical presentation of Guillain-Barré Syndrome.
Ascending symmetrical muscle weakness.
Areflexia (loss of reflexes).
Sensory symptoms (e.g., paresthesia, numbness).
Autonomic dysfunction (e.g., tachycardia, labile blood pressure).
Cranial nerve involvement (e.g., facial weakness).
True/False: Weakness in Guillain-Barré Syndrome typically progresses in a descending pattern.
False. It progresses in an ascending pattern.
The hallmark feature of Guillain-Barré Syndrome is ______ symmetrical weakness with areflexia.
Ascending.
What investigations are used to diagnose GBS?
Lumbar puncture: elevated CSF protein with normal white cell count (albuminocytologic dissociation).
Nerve conduction studies: evidence of demyelination.
Blood tests: rule out differential diagnoses.
A lumbar puncture in GBS typically shows elevated CSF protein and a high white cell count.
False. White cell count is typically normal.
Elevated ______ levels with normal white cell count on lumbar puncture suggest GBS.
CSF protein.
What are the key components of Guillain-Barré Syndrome management?
Supportive care: respiratory support if required.
Immunotherapy: IV immunoglobulin (IVIG) or plasma exchange.
Monitor autonomic and respiratory function.
True/False: Oral steroids are the first-line treatment for Guillain-Barré Syndrome.
False. Steroids are not effective in GBS.
The two main immunotherapy treatments for GBS are IVIG and ______ exchange.
Plasma.
What is the prognosis of Guillain-Barré Syndrome?
Most patients recover fully within weeks to months, but some may experience persistent weakness or fatigue. Mortality is around 5% due to complications.
True/False: The majority of Guillain-Barré Syndrome patients recover fully.
t
Persistent ______ or fatigue may occur in some GBS patients after recovery.
Weakness
List complications associated with GBS.
Respiratory failure.
Autonomic dysfunction (e.g., arrhythmias, blood pressure instability).
Deep vein thrombosis (DVT) due to immobility.
True/False: Autonomic dysfunction in GBS can lead to life-threatening complications.
t
Immobility in GBS increases the risk of ______ thrombosis.
Deep vein
