Systemic and Metabolic Disorders Flashcards
What will an EEG typically show with a toxic-metabolic encephalopathy?
slowing of the background rhythm
What is the cardinal clinical feature of encephalopathy?
waxing and waning level of consciousness
What is a frequent physical exam finding in encephalopathy?
asterixis, which is an example of negative myoclonus
Sarcoidosis only affects the CNS in about 5% of cases. What is the most common presentation?
cranial neuropathy due to chronic basal meningitis with the facial and optic nerves most frequently affected
Facial neuropathy may occur due to parotid inflammation
visual changes are common due to direct involvement of the optic nerves
What is the typical pathology of sarcoidosis?
noncaseating granuloma
We usually don’t like to do brain biopsies to confirm neurosarcoid, but what will CSF analysis show?
elevated protein and lymphocytic pleocytosis
CSF ACE concentration is difficult to interpret, but serum ACE concentration will be high
What is the most common neurological complication of diabetes?
peripheral neuropathy
Describe the typical presentation of peripheral neuropathy
distal symmetric sensory polyneuropathy affecting temperature and pinprick sensation first (2/2 predilection for small myelinated and unmyelinated fibers)
An associated autonomic neuropathy is common. What are some of the symptoms?
gustatory sweating, orthostatic hypotension, diarrhea and impotence
neurogenic bladder and gastroparesis occur less frequently
What are some acute neurological effects of hyperglycemia?
seizures
transient painful peripheral neuropathy that resolves with correction of the hyperglycemia
chorea
What is the clinical triad seen in Wernicke’s encephalopathy?
ophthalmoplegia
truncal ataxia
confusion
Gait ataxia greater than limb ataxia and dysarthria in a long-time alcoholic usually is caused by what?
cerebellar degeneration
Describe the vision change that occurs with tobacco-alcohol amblyopia?
an insidious and painless loss of vision in a centrocecal scotoma pattern
Alcohol can cause a focal demyelination and necrosis of the corpus callosum leading to frontal-type dementia, seizures and pyramidal signs. What is this syndrome called?
Marchiafava-Bignami syndrome
Subacute combined degeneration of the spinal cord results from deficiency of what?
Vitamin B12
What happens in subacute combined degeneration of the spinal cord?
degeneration of the posterior and lateral white matter tracts of the spinal cord, so you get paresthesias in the hands and feet with eventual weakness and spasticity in the legs
often associated with a large-fiber peripehral neuropathy and macrocytic anemia
What lab tests should you do to check for B12 deficiency?
B12 levels may be normal, so you need to measure levels of serum homocysteine and methylmalonic acid (which are the precursors of B12 and will thus be elevated when B12 is deficiency as the body tries to compensate)
What are some of the CNS manifestations of SLE?
psychosis and depression are the most common
also seizures, stroke (bc of being hypercoagulable), transverse myelitis, headache and chorea
What is the most common PNS manifestation of SLE?
distal sensory polyneuropathy
What are the major features of antiphospholipid syndrome?
venous and arterial thrombosis (more often venous)
recurrent fetal loss
thrombocytopenia
What is the management for antiphospholipid syndrome?
long-term warfarin to INR of 3-4
