Neuro shelf - systemic and metabolic disorders

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Neuro shelf - systemic and metabolic disorders
2011-09-18 11:46:03

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  1. hepatic encephalopathy
    progresses rapidly, presence of waxing and waning cerebral dysfunction in the setting of liver failure.

    impaired attention and concentration, altered sleep patterns, abnormal visuospatial perception, and subtle personality changes. Increased muscle tone, hyperreflexia, and extensor plantar responses

    due to accumulation of neurotoxic substances leading to increased brain glutamine concentrations, depressed glutamatergic neurotransmission, and increased expression of the peripheral-type benzodiazipine receptors

    path: alzheimer type II astrocyte that are metabolically hyperactive
  2. neurologic manifestations of systemic disease...

    polyarteritis nodosa
    mononeuropathy multiplex, seizures, stroke
  3. neurologic manifestations of systemic disease...

    mononeuropathy multiplex, encephalopathy, stroke, chorea
  4. neurologic manifestations of systemic disease...

    giant cell arteritis
    headache, blindness, polyneuropathy, stroke
  5. neurologic manifestations of systemic disease...

    wegner granulomatosis
    mononeuropathy multiplex, cranial neuropathy, basal meningitis
  6. neurologic manifestations of systemic disease...

    rheumatoid arthritis
  7. neurologic manifestations of systemic disease...

    sjogren syndrome
    sensory polyneuropathy
  8. neurologic manifestations of systemic disease..

    behcet disease
    aseptic meningoencephalitis
  9. neurologic manifestations of systemic disease...

    TIA, stroke, peripheral neuropathy
  10. neurologic manifestations of systemic disease...

  11. neurologic manifestations of systemic disease...

    thrombotic thrombocytopenic purpura
    encephalopathy, seizures, stroke
  12. neurologic manifestations of systemic disease...

    whipple disease
    dementia, seizures, myoclonus, atazia, supranuclear ophthalmoplegia, oculomasticatory myorhythmia
  13. neurosarcoidosis
    pulmonary disease most common in sarcoidosis but can affect any part of the nervous system

    chronic neuropathy due to chronic basal meningitis is most common presentation, with facial and optic nerves most frequently affected. facial neuropathy may also be due to parotid inflammation

    path: non-caseating granulomata. CSF ACE may be elevated, tx with steroids
  14. disorders characterized by noth diabetes and neurologic symptoms
    • mitochondrial diseases
    • myotonic dystrophy
    • Friedrich ataxia
    • stiff-man syndrome
  15. diabetes neuro
    predilection for involvement of small myelinated and unmyelinated fibers, with resulting loss of temperature and pinprick sensation. associated autonomic neuropathy (gustatory sweating, orthostatic hypotension, diarrhea, and impotence)

    thoracic radiculopathy - truncal sensory loss, focal weakness of muscles of anterior abdominal wall, nonradicular pain
  16. diabetic amyotrophy
    proximal diabetic neuropathy
  17. nonketotic hyperglycemia neuro symptoms
    lethargy and drowsiness with focal or generalized seizures, sometimes dystonia of chorea
  18. hypoglycemia neuro symptoms
    headache, blurred vision, dysarthria, confusion, seizures, and coma. repeated episodes may produce injury to anterior horn cells of spinal cord resulting in syndrome similar to ALS
  19. deficiency of thiamine, niacin
    confusion and encephalopathy
  20. deficiency of B12, folate, niacin
  21. deficiency of pyridoxine, niacin
  22. deficiency of vit E, niacin
  23. deficiency of B12, E, niacin
  24. deficiency of thiamine, pyridoxine, B12, E, niacin
    peripheral neuropathy
  25. Wernike's encephalopathy
    opthalmoplegia, truncal ataxia, confusion developing over days or weeks

    may be precipitated by the administration of IV glucose
  26. Subacute combined degeneration of spinal cord
    B12 deficiency

    degeneration of posterior and lateral white matter tracts of the spinal cord. dorsal columns and lateral cotricospinal tracts. presentation insidious onset of paresthesias in hands and feet with weakness and spasticity in legs. large-fiber peripheral neuropathy, macrocytic anemia.

    normal serum B12 levels do NOT preclude diagnosis, need to measure levels of serum homocysteine and methylmalonic acid (elevated when B12 deficient)
  27. antiphospholipid syndrome
    venous or arterial thrombosis, recurrent fetal loss, and thrombocytopenia are associated with elevated titers of antibodies against phospholipids.

    young pts with stroke, suspect. diagnosis requires demonstration of high-titer IgG antiphopholipid antibodies on 2 occasions at least 6 weeks apart
  28. Neurologic manifestations of hypothyroidism
    • mental state: poor concentration and memory, dementia, psychosis, coma
    • seizures
    • headaches: pseudotumor cerebri
    • cranial nerves: papilledema, ptosis, tonic pupil, trigeminal neuralgia, facial palsy, tinnitus, and hearing loss
    • cerebellar ataxia: truncal and gait ataxia more than limb ataxia, dysarthria, nystagmus
    • muscles: cramps, pain and stiffness, proximal more than distal, CK may be increased
    • worsening of myasthenia gravis
    • nerves: entrapment neuropathy, axonal polyneuropathy (improves with thyroxine replacement), delayed relaxation of DTRs
    • sleep apnea: central and obstructive
  29. neuro symptoms of hyperthyroidism
    periodic paralysis and proximal myopathy, seizures, chorea, and dysarthria, association with myasthenia gravis
  30. central pontine myelinolysis
    demyelinating disorder often in alcoholic pts, may be precipitated by too rapid correction of hyponatremia

    presents with acute confusional state, spastic quadriparesis, locked-in syndrome, dysarthria, and dysphagis