Toxic-Metabolic Flashcards
1
Q
A 45 year-old man was found down unconscious, his wife dead beside him.
A
Carbon monozide poisoning
Clinical features
- Nausea, headache, fatigue
- Apathy, rigidity, bradykinesia, dystonia
- Can be fatal
Imaging
- Hyperintensity of globus pallidus
Treatment
- 100% oxygen
2
Q
A 48 year-old man admitted for alcohol withdrawal, became encephalopathic and parkinsonized in hospital.
A
Central pontine myelinosis (CPM)
Background
- Demyelinating disorder due to rapid correction of longstanding hyponatremia leading to shifts in free water
- Most common in alcoholics + malnourished
- Can also occur in striatum (caudate + putamen)
Clinical features
- Parkinsonism, coma, quadraparesis, locked-in-syndrome
- Bulbar dysfunction
Imaging
-
“Trident sign”
- Hyperintensity of pons, sparing corticospinal tracts
3
Q
A 33 year-old man with dystonia, choreoathetoid movements, and neuropsychiatric dysfunction. Serum biochemical profile is normal.
A
Familial cerebrovascular ferrocalcinosis (Fahr’s disease)
Background
- Bilateral, symmetric calcifications of basal ganglia, thalamus, dentate nucleus of cerebellum
Clinical features
- Movement disorders
- Psychiatric impairment
4
Q
65 year-old alcoholic man developed encephalopathy.
A
Hepatic encephalopathy
Background
- Bilateral, symmetric hyperintense lesions in basal ganglia (globus pallidus)
- Due to impaired metabolism of metals (manganese and copper)
- Chronic liver failure
Clinical features
- Encephalopathy
- Movement disorders - asterixis
5
Q
A 34 year-old man with a long history of seizures and ataxia since childhood.
A
Atrophic cerebellum due to anti-epileptic (AED)
- Phenytoin is big culprit
- Alcohol abuse can do this as well
