Neuro Lect 7

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Neuro Lect 7
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  1. What are the disorders of cognitive function that cause acute confusion (delirium)?
    • stroke
    • alcohol withdrawal
    • endocrine
    • electrolyte disturbance
    • nutritional disorders
    • organ system failure
    • psychiatric
  2. What infectious disorders can cause disorders of cognitive function?
    • encephalitis: west nile, polio, rabies
    • meningitis: acute (bacterial, fungal), chronic (fungal, TB)
    • cerebral malaria
    • syphilis
  3. What disorders of cognitive function can be due to a result of concussion or a mild brain injury?
    • alzheimer's disease
    • lewy bodies
    • vascular dementia
  4. When evaluating for new altered mental status, prior medical history on what body systems should always be asked about/examined?
    • cardiovascular disease
    • DM
    • seizures
    • head trauma
    • alcoholism/drug use
    • psych history
  5. What is included in a general mental status exam?
    • general behavior & appearance
    • stream of talk
    • mood & affective response
    • content of thought
    • sensorium
    • mini mental status exam (<24/30 needs more testing)
  6. What is the included in a formal mental status exam?
    • LOC
    • attention & concentration
    • language & speech
    • mood & behavior
    • content of thought
    • memory
    • integrative sensory & motor function
  7. Ability to focus on a particular sensory stimulus (sustained=concentration), is typically grossly impaired in delirium but not so much with dementia, and is tested by serial 7s or identifying a letter in a series w/o error.
    attention (mental status exam)
  8. What are the essential elements of language & speech tested for with the mental status exam?
    • comprehension
    • repetition
    • fluency
    • naming
    • reading
    • writing
    • speech
  9. Type of aphasia in which fluency & comprehension is preserved, and repetition is impaired caused by a lesion in the arcuate fasciculis.
    conduction aphasia
  10. Type of aphasia in which fluency is impaired, repetition & comprehension is preserved, pt may have an associated right hemiparesis, is caused by a lesion near Broca's area.
    transcoritcal motor aphasia
  11. Type of aphasia in which fluency and repetition is preserved, comprehension is impaired, is caused by a lesion in Wernicke's area.
    transcortical sensory aphasia
  12. Type of aphasia in which fluency, repetition, and comprehension is impaired, pt may have associated severe right hemiparesis, is caused by a large lesion in the left hemisphere.
    global aphasia
  13. Type of aphasia in which fluency and comprehension are variable, pt may have associated hypophonia, is caused by a lesion in the left basal ganglia or thalamus.
    subcortical aphasia
  14. Disturbed memory in which pt can't remember emotionally charged events but can remember objective facts and events.
    psychogenic amnesia
  15. Disturbed memory in which pt can't remember objective facts.
    organic amnesia
  16. Disturbed memory in which pt loses memory for event immediately prior to the disorder (head trauma).
    retrograde amnesia
  17. How is memory tested?
    immediate, recent, and remote recall
  18. What things are tested for when checking integrative sensory function?
    • asterognosis
    • agraphasthesia
    • 2 point discrimination
  19. What are the historical red flags for acutely confused patients?
    • progressively declining LOC/neuro exam
    • pupillary asymmetry
    • seizures
    • repeated vomiting
    • double vision
    • worsening HA
    • disorientation (can't recognize people/places)
    • unusual behavior (confused/irritable)
    • slurred speech
    • unsteady on feet
    • weakness/numbness in arms or legs
  20. What is the acronym for causes of dementia?
    • I WATCH DEATH
    • I: infection (HIV, sepsis, UTI, pneumonia)
    • W: withdrawal (ETOH, drugs, sedatives)
    • A: acute metabolic (acidosis/alkalosis, electrolytes, renal failure, liver failure)
    • T: trauma (closed head injury, heat stroke)
    • C: CNS pathology (seizure, tumor, vasculitis, encephalitis, meningitis, syphilis)
    • H: hypoxia (anemia, CO poisoning, HOTN, heart/lung failure)
    • D: deficiencies (vit B12, folate, niacin, thiamine)
    • E: endocrinopathies (hyper/hypoadrenalcorticism, sugar, thyroid)
    • A: acute vascular (stroke, HTN, encephalopathy, arrhythmia, shock)
    • T: toxins (Rx drugs, illicit drugs, pesticides, solvents)
    • H: heavy metals (lead, manganese, mercury)
  21. Type of memory that lasts <30 seconds, can recall 7 bits of info (+/-2), vulnerable to distraction, anatomically related to the RAS, prefrontal cortex, and parietal lobe, and is tested with recalling digits backwards.
    working memory
  22. Type of memory that lasts minutes to months, "lays down" significant memories throughout the day, is anatomically related to the hippocampus and dorsomedial nucleus of the thalamus. Is tests with word recall @ 3-5 mins or by asking about trivial events during the day (what they had for breakfast, etc).
    episodic memory
  23. Type of memory that is lifelong (related to new protein synthesis and creation of new synapses), is anatomically related to the left anterior temporal lobe and frontal lobe.
    lasting memory
  24. This can occur as a feature of an acute confusional state, dementia, or isolated abnormality.
    amnestic disorder
  25. What are the acute causes of amnestic syndromes?
    • head trauma
    • hypoxia/ischemia
    • bilateral cerebral artery occlusion
    • transient global amnesia
    • alcoholic blackouts
    • wernicke encephalopathy
    • dissociative (psychogenic) amnesia
  26. What are the chronic causes of amnestic syndromes?
    • alcoholic Korsakoff amnestic syndrome
    • postencephalitic amnesia
    • brain tumor
    • paraneoplastic limbic encephalitis
    • accompanying dementias
  27. Generalized loss of memory (psychogenic/organic). Acutely confused pt my have impaired attention & inability to learn new material. Demented pts have normal attention span with problems with recent memory (remote memory intact).
    amnesia
  28. Mental activities involved in planning, initiating, and regulating behavior. Is considered the central organizing function of the brain and is highly dependent on working memory, primarily involves the frontal lobe, and is diminished/lost in many types of dementia.
    executive function
  29. Condition typically ACUTE in onset, responds to at least some stimuli appropriately, pt can appear sleepy/disoriented/inattentive (LOC may be impaired), can occur at any age and is typically reversible.
    delirium
  30. Condition typically CHRONIC in onset with worsening over time, pt usually appears "normal" but confused, normal LOC with impairment in the content of consciousness, is typically more common in elderly (associated with age) and is irreversible.
    dementia
  31. Acute change in mental status (hours to days) with a disturbance of consciousness that results from an underlying medical cause. Hallmark is waxing and waning levels of consciousness.
    delirium
  32. How is delirium mainly differentiated from dementia?
    • by the history
    • Note: short onset within hours to a few weeks favors delirium, chronic disturbance/gradual onset favors dementia
  33. what is the hallmark description for delirium?
    waxing and waning levels of consciousness
  34. What are the key features of delirium?
    • attention impairment
    • memory impairment & disorientation
    • agitation
    • apathy/withdrawal
    • sleep disturbance
    • emotional lability
    • perceptual disturbances
    • neurologic signs
  35. Progressive decline in cognitive function beyond what might be expected from normal aging. Symptoms vary and slowly progress but all do involve loss of cognitive skills, especially learned tasks (apraxia). Recent memory is what is usually markedly affected (long term is affected last). Pts have normal level of consciousness.
    dementia
  36. What are degenerative causes for dementia?
    • Alzheimer-type disease
    • Parkinson's disease
  37. What are vascular causes for dementia?
    • multi-infarct
    • arteritis
  38. What are the CNS conditions that can cause dementia?
    • strokes
    • seizures
    • hematoma
    • infection
    • severe hypotension
    • vasculitis
  39. What are the conditions occurring in the chest that can cause dementia?
    • congestive heart failure
    • hypercapnia
    • hypoxemia
    • rhythm disturbance
    • acute MI
  40. What conditions other than degenerative, chest, or CNS conditions can cause dementia?
    • vitamin B12 deficiency (general vitamin deficiency)
    • chronic alcoholism
    • subdural hematoma
    • hydrocephalus
    • chronic seizures
    • hypothyroidism
    • hearing loss
    • blindness
    • depression (rule it out)
  41. What are selected causes for delirium?
    • stroke
    • alcohol intoxication/withdrawal
    • drug use
    • endocrine disturbances
    • electrolyte disturbances
    • nutritional disorders
    • organ system failure
    • psychiatric disorders
    • hypertensive encephalopathy
    • concussion
  42. What are the types of drugs that can cause delirium?
    • anticholinergics
    • narcotics
    • antidepressants
    • anxiolytics
    • methylodopa, clonidine
    • B blockers
    • steroids
    • NSAIDS including ASA
    • phenytoin
    • digoxin
    • ethanol
    • cimetidine
  43. What are the systemic changes that can cause delirium?
    • infection (febrile or afebrile)
    • vitamin deficiency
    • fecal impaction
    • urinary retention
    • any abdominal disorders
  44. What are the metabolic conditions that can cause delirium?
    • renal failure
    • liver failure
    • anemia
    • thyroid dysfunction
    • adrenal dysfunction
    • hyperglycemia/hypoglycemia
    • hypercalcemia
  45. What physical and environmental situations cause delirium?
    • stress of any type or source
    • change in environment
    • surgery
    • anesthesia
    • sleep loss
    • pain
    • fever or hypothermia
    • hypoxia, hypercarbia
  46. An acutely confused patient that presents with nystagmus, dysarthria, limb and gait ataxia is most likely suffering from what?
    • alcohol intoxication
    • Note: alcohol level does not necessarily predict symptoms
  47. An acutely confused patient that presents initially with tremulousness, tachycardia and hypertension is most likely suffering from what? How is it treated?
    • alcohol withdrawal
    • tx with benzos (i.e. diazepam 5-20mg q4h prn)
  48. When do seizures from alcohol withdrawal usually manifest?
    about day 2 (continue tx with benzos)
  49. When does delirium tremens usually develop from alcohol withdrawal? How is it treated?
    • day 3-5
    • diazepam 10-20mg IV q5 mins pen until calm, correct fluid/electrolyte/glucose abnormalities, B-blocker (i.e. atenolol 50-100mg po qd) to block adrenergic response
  50. What are the signs and symptoms of delirium tremens (DTs)?
    • agitation
    • tremulousness
    • hallucinations
    • cardiovascular collapse
  51. Acute confusion in a patient caused by thiamine deficiency due to chronic alcoholism, patient also presents with ophthalmoplegia/nystagmus, and gait ataxia.
    Wernicke's encephalopathy (requires prompt thiamine replacement, 100mg IV/IM for 5 consecutive days)
  52. What treatment can precipitate or worsen Wernicke's encephalopathy?
    administration of glucose without thiamine
  53. Nutritional disorder that presents with mild confusion to dementia to psychosis. Occurs in patients who have had gastric bypass, alcoholics, chronic users of acid blockers but is usually due to poor intake.
    • vitamin B12 deficiency
    • Note: tx with IM injections monthly due to poor GI absorption (aka pernicious anemia)
  54. For practical purposes, all patients with undiagnosed altered mental status, oculomotor disorders or ataxia should receive what treatment?
    • thiamine 100mg IV (may consider glucose bolus first since ONE dose isn't likely to worsen the problem)
    • Note: ataxia may not be fully reversible, deficits in learning and memory may follow
  55. Infection of the brain's subarachnoid space.
    meningitis
  56. Infection of the brain tissue itself.
    encephalitis
  57. What three criteria in CSF are helpful in the diagnosis of bacterial meningitis?
    • WBC >/= 500/uL
    • glucose to blood glucose ratio of </= 0.4 (low CSF glucose)
    • lactate level of >/= 31.35 mg/dL
  58. What are infectious disorders that can cause encephalitis?
    • west nile virus
    • polio
    • rabies
    • syphilis
  59. What are infection disorders that can cause meningitis?
    • acute: bacterial, fungal
    • chronic: fungal, TB
  60. What are the two major pathways in which meningitis can be contracted and what are examples for each?
    • invasion of the bloodstream: bacteremia, viremia "aseptic meningitis", fungemia, parasitemia
    • direct contiguous spread: sinusitis, otitis media
  61. What are the general signs and symptoms of meningitis?
    • fever
    • headache
    • neck stiffness
    • photophobia
    • nausea
    • vomiting
    • toxic appearance
    • fever to 104
    • papilledema
    • meningismus
    • rash
    • other sources of infection (middle ear, sinuses, lungs, UTI, wounds)
  62. What is the classic triad found in 2/3 of patients with meningitis?
    • fever
    • nuchal rigidity
    • mental status changes
  63. What is a positive Kernig's test?
    pt does not allow knee extension when hip is flexed
  64. What is a positive Brudzinski's test?
    pt resists passive flexing of the chin onto the chest, brings knees up in response
  65. What can a lumbar puncture reveal in a patient with meningitis?
    • cloudy CSF
    • high protein
    • high lactate
    • low glucose
    • many WBCs
  66. What may an MRI show in a patient with meningitis?
    • edema
    • inflammation
  67. What are the rules of thumb for meningitis patients?
    • 1) empiric therapy should be initiated whenever bacterial meningitis is suspected
    • 2) LPĀ everyone you suspect that COULD have meningitis (don't delay abx!)
    • 3) viral meningitis seldom presents with depressed mental status, seizures, or focal neurologic deficit
  68. When do you need to CT or MRI a pt before performing a lumbar puncture in a suspected case of meningitis?
    • recent head trauma
    • immunocompromised
    • known metastatic lesions or CNS tumor
    • anyone with focal neuro findings (papilledema, decreased level of consciousness)
  69. What clinical signs may be observed with meningitis?
    • headache
    • neck stiffness
    • fever
    • clouded consciousness
  70. What were the most common pathologic agents that caused bacterial meningitis before vaccines (HIB) were available?
    • H influenzae
    • N meningitidis
    • S pneumoniae
  71. Now due to the HIB meningitis vaccine cases of bacterial meningitis have decreased by 90%, however it is still an issue for some namely adults. What is the organism most responsible for adult bacterial meningitis?
    penicillin resistant S pneumoniae
  72. What is the bacterial empiric therapy for meningitis by predisposing features?
    • <3 months old: ampicillin plus (cefotaxime/ceftriaxone) vancomycin
    • 3 months to 50 years old: (ceftriaxone/cefotaxime) plus vancomycin
    • >50 years old: ampicillin plus ceftriaxone or ceftriaxone plus vancomycin
    • impaired cellular immunity: ampicillin plus ceftazidime plus vancomycin
    • neurosurgery, head trauma, or CSF shunt: vancomycin plus ceftazidime plus ampicillin
  73. What are the steps in treatment and procedures performed for meningitis?
    • 1) begin abx ASAP if bacterial meningitis is suspected (empiric=penicillin 24 million units/day in 6 divided doses, ceftriaxone 6 gm/day in 3 divided doses, vancomycin 2gm/day in 2 divided doses)
    • 2) evacuate immediately
    • 3) airway support and O2 (intubate as needed)
    • 4) fluid hydration with IV NS or LR
    • 5) control fever with Tylenol
    • 6) if viral meningitis is suspected give acyclovir 12.5 mg/kg/day IV divided TID for 10 days
    • 7) consider steroids (decadron 0.4 mg/kg q12 hr for 4 doses) with first dose prior to starting abx
  74. What clinical sign is characteristic of Neisseria meningitidis?
    purpuric rash
  75. What is the goal in treating bacterial meningitis?
    to begin ABX therapy within 60 minutes of arrival to ER!
  76. What is the basic empiric therapy for bacterial meningitis?
    • ceftriaxone
    • vancomycin
  77. What factors are part of a poor prognosis for patients with meningitis?
    • extremes of age
    • delay in diagnosis and/or treatment
    • stupor/coma
    • seizures
    • focal neurologic signs
  78. What is the most common type of encephalitis?
    viral
  79. What are common viruses that cause encephalitis and how are they transmitted?
    • enterovirus: fecal-oral transmission
    • HSV, VZV: human to human transmission
    • arboviruses: mosquitoes, ticks (ie west nile)
  80. Type of encephalitis caused by a virus that directly invades the brain and spinal cord.
    primary encephalitis
  81. Type of encephalitis caused by a virus that first infects another part of the body.
    secondary (post infectious) encephalitis
  82. What is the most common cause of fatal encephalitis in the US? How is it contracted/developed?
    • herpes viruses (HSV, VZV)
    • human to human transmission/reactivation of latent virus
  83. What is the antiviral treatment for encephalitis?
    acyclovir 10-15 mg/kg IV q8 hours for 14-21 days (start ASAP!!)
  84. What are the signs and symptoms of encephalitis?
    • hemiparesis
    • focal seizures
    • autonomic dysfunction
    • ataxia
    • dysphagia
    • altered mental status
    • meningismus
  85. What are the labs and tests that should be performed to diagnose encephalitis?
    • head CT: with AND without contrast, before LP to search for elevated ICP, obstructive hydrocephalus, and mass effect
    • MRI: more likely to show abnormalities
    • EEG: diffuse slowing
    • CSF: nl or slightly increased protein, lymphocytes present, normal glucose
  86. What is the general treatment for encephalitis?
    • appropriate management of the airway
    • fluid & electrolyte balance
    • nutrition
    • avoid & treat secondary infection
    • treat hyperpyrexia
    • manage ICP (head elevation, diuresis, mannitol, seizure precautions)
  87. What labs should be run on an acutely confused patient?
    • WBC (r/o infection)
    • ABG
    • chem 7 (Na, BUN, creatinine, glucose)
    • serum osmolality
    • LFTs
    • thyroid function tests
    • serum & urine drug screen (including ETOH level)
    • head CT (or MRI if pt is "stable")
  88. What are the historical red flags for the acutely confused patient?
    • progressively declining level of consciousness/neuro exam
    • pupillary asymmetry
    • seizures
    • repeated vomiting
    • double vision
    • worsening headache
    • disorientation (can't recognize people/places)
    • confused, irritable, strange behavior
    • slurred speech
    • unsteady on feet
    • weakness/numbness in arms or legs
  89. A disorder involving impairment of learning & memory and one or more of the following: impaired ability to perform complex tasks, impaired reasoning ability, spacial orientation or language.
    • dementia
    • Note: simple definition is deterioration in cognitive abilities that impairs previously successful performance of activities of daily living
  90. Prevalence of dementia types depends on the population. What types are most prevalent in western society?
    • alzheimer's (50-60%)
    • vascular (10-20%)
    • parkinson's (often with lewy bodies)
    • chronic intoxication
  91. What are the three most common reversible causes of dementia?
    • depression
    • hydrocephalus
    • alcohol dependence
  92. What is the biggest risk factor for developing dementia?
    • increasing age!
    • Note: prevalence increases over age 50, microscopic changes consistent with alzheimer's is the most common autopsy finding
  93. What is the course of cognitive impairment with normal aging?
    • subtle decline in episodic memory
    • no affect on daily life
    • age is the single greatest risk factor for cognitive decline
  94. What are the signs/symptoms of mild cognitive impairment?
    • typically mild cognitive deficits
    • interferes with daily life
    • major risk factor for frank dementia
  95. What are the risk factors of mild cognitive impairment turning into frank dementia (usually alzheimer's type)?
    • memory deficit >1.5 SD from normal
    • presence of apolipoprotein e4 allele
    • small hippocampal volume
  96. What are the four major classes of dementia to aware of that are each associated with aggregation of an abnormal protein?
    • alzheimer's: AB42
    • frontotemporal dementia: tau
    • lewy body dementia (DLB): a-synuclein
    • prion disorders: PrP
  97. Most common cause of dementia in the US, characterized macro and microscopically.
    alzheimer's disease
  98. What are the macroscopic characteristics of alzheimer's disease?
    diffuse cortical atrophy
  99. What are the microscopic characteristics of alzheimer's disease?
    • neuritic plaques of AB42 amyloid
    • silver staining neurofibrillary tangles in neural cytoplasm
    • accumulation of AB42 amyloid in arterial walls of cerebral blood vessels
  100. A progressive neurological disorder that results in memory loss (typically first finding), language and visual spacial deficits, and anosognosia (lack of awareness of cognitive deficits) in most patients. Symptoms begin gradually but progress to involve daily life.
    alzheimer's disease
  101. What are the factors for increased risk of developing alzheimer's disease?
    • female (female to male ratio is 2:1)
    • positive family hx
    • more common in lower educated populations
    • head trauma (minor risk)
  102. Where is the pathology of alzheimer's disease localized to?
    • hippocampus
    • temporal cortex
    • lateral septum (nucleus of Meynert)
  103. What are the key findings in the brain for people with alzheimer's disease?
    • senile plaques
    • neurofibrillary tangles
  104. What are "senile plaques"?
    collections of degenerative presynaptic endings (cannot see this on MRI!)
  105. Cortical atrophy leads to ________ of the ventricles.
    compensatory dilation
  106. What is the general course of alzheimer's disease symptoms?
    • gradual development of forgetfulness (major symptom) often first noticed by family
    • halting speech (can't recall word), eventually speech becomes restricted
    • progresses to disorientation to time then place
    • motility, behavior, temperament, and conduct begin to decline (pt gets restless, agitated, depressed)
    • symptoms progress over 7-15 years
  107. What are the early signs/manifestations of alzheimer's disease?
    • non-focal neuro exam
    • abnl short term memory
    • hesitant speech
    • score of 24-27 on MMSE
  108. What are the later signs/manifestations of alzheimer's disease?
    • language, cognition decline
    • paranoia, hallucinations, delusions
    • primitive reflexes emerge
    • pt becomes mute, bed bound, incontinent
    • seizures
  109. What are the diagnostic studies used to identify alzheimer's disease?
    • MRI, CT: no difference than mentally intact elderly early on, later shows enlarged ventricles (lateral and 3rd), widened cerebral sulci and hippocampal atrophy
    • neuropsychiatric testing: deterioration in memory and verbal skills; decreased "executive functioning"
    • apo e testing: useful to confirm dx
  110. What are the cholinesterase inhibitor medications used to treat alzheimer's disease?
    • tacrine
    • donepezil
    • rivastigmine
    • galantamine
  111. What are the NMDA receptor antagonist medications used to treat alzheimer's disease?
    memantine
  112. What is the MOA for the medications that treat alzheimer's disease and what effect do they have?
    • they increase CNS levels of ACh
    • slows progression of cognitive decline (avg pt maintains MMSE at 1 yr compared with placebo)
  113. Which medication has been approved for use in moderate to severe alzheimer's disease? What are the main side effects?
    • namenda (memantine)
    • nausea, other GI effects
  114. Condition also known as multi-infarct dementia, meaning dementia arising from vascular insult, that lacks a uniform set of criteria.
    • vascular dementia
    • Note: cerebrovascular disease may play a role in the presence and severity of AD symptoms, silent infarcts may also increase the likelihood of dementia
  115. What are the findings that suggest vascular dementia as a diagnosis?
    • cognitive deficit onset associated with a stroke
    • abrupt onset with stepwise deterioration
    • focal findings on neuro exam consistent with CVA
    • infarcts seen on imaging
  116. White matter infarcts that cause patients to present with apathy, agitation, and bilateral corticospinal or bulbar signs.
    binswagner's disease
  117. Class of dementia that comes on between 50-70 years of age that is characterized by early behavioral symptoms, and is associated with marked atrophy of temporal and frontal lobes.
    • frontotemporal dementia (FTD)
    • Note: microscopically associated with tau protein accumulation within neurons
  118. Dementia syndrome characterized by visual hallucinations, parkinsonism (symptoms often begin before dementia, and respond with delirium to L-dopa), fluctuating alertness, and falling.
    • dementia with lewy bodies
    • Note: microscopically reveal lewy bodies throughout the cerebral cortex
  119. What are general causes for reversible dementia?
    • depression (most common)
    • normal pressure hydrocephalus
    • metabolic disorders
    • medication induces
    • alcohol related
    • malignancy
    • chronic subdural hematomas
    • chronic meningitis
  120. Condition most commonly mistaken for dementia. Both conditions tend to show mental slowness, apathy, self-neglect, irritability, difficulty with memory, etc.
    • depression (pseudodementia)
    • Note: all patients with suspected dementia must be screened for depression
  121. What are the features of dementia that distinguish it from depression?
    • pt is unaware of deficit extent
    • no complaints of memory loss
    • few vegetative symptoms
    • worse at night
    • abnormal neuro exam
    • possibly abnormal labs
  122. What are the features of depression that distinguish it from dementia?
    • pt is aware of deficits
    • complains of memory loss
    • prominent vegetative symptoms
    • not worse at night
    • normal neuro exam
    • normal labs
  123. How and when is pseudodementia (depression) treated?
    • SSRI, SNRI
    • CBT
    • following co-morbidities
    • Note: anticipate relatively rapid improvement in function
  124. What is the classic triad that patients with normal pressure hydrocephalus present with?
    • cognitive decline
    • urinary incontinence
    • gait difficulty
  125. How is normal pressure hydrocephalus managed?
    shunt
  126. Syndrome that shows damage mostly in the thalamus and other midline structures occurring in the presence of a LONG STANDING thiamine deficiency.
    Korsakoff's syndrome
  127. What is the classic presentation for thiamine deficiency?
    • confusion
    • gait disturbances
    • ophthalmoplegia
  128. What cancers can cause reversible dementia, and where would it be located to cause the dementia?
    • primary or secondary
    • frontal cortex of the temporal lobe
  129. What is the term used to describe reversible dementia caused by recurrent head trauma?
    dementia pugilistica
  130. What is the general symptomatic treatment for reversible dementia?
    • identify and tx reversible cause
    • remove sedating meds/cognitive impairing drugs
    • tx depression aggresively
    • tx behavioral problems by addressing environmental cues (reorienting, exercise, memory aides) or using antipsychotics

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