Encephalopathy

Question 1

Acute encephalopathy =

Answer 1

Delirium

Question 2

Delirium vs Dementia

Answer 2

Dementia = baseline has deficits

Delirium = baseline is normal, something causing deficits

Question 3

Encephalopathy S/s history

Answer 3

Aphasia
Mania
Psychosis
Depression
Transient Global Amnesia (TGA)

Question 4

Hallucinations

Psyc vs. organic brain dz

Answer 4

Psyc = auditory

Organic brain dz = visual

Question 5

Present w/ delirium?

Answer 5

Promp evaluation

Question 6

Delirium = Neurons? Neurotransmitters?

Answer 6

Neurons = cortical + subcortical

NT =
Ach,
Dopa

Question 7

Encephalopathy risks

Answer 7

Old
Dementia
Critically ill
Immunocompromised

Question 8

Confusion differential?

Answer 8

Infxn

Question 9

Which electrolytes can cause confusion?

Answer 9

Mg
Ca
Glucose
Na

Question 10

Replace Na too quickly =

Answer 10

Central pontine myelinosis (CPM) = brain demyelination (pons)

Question 11

Confusion: metabolic differential

Answer 11

• Electolyte (Mg, Ca, Glucose, Na)
• Hyperosmolality
• Central pontine myelinosis
• acidosis/alkalosis

Question 12

Confusion : Organ failure differential

Answer 12

• Respiratory
• CV
• Iiver
• renal

Question 13

HX

Answer 13

HA =

• acute: SAH, ICH
• progressive: CNS tumor, infxn, hydrocephalus

Previous Brain damage
*try to doc baseline

Preexisitng conditions
*cardio/lung

Drugs/Meds

Exposure (Mening, HIV, CO, work)

Question 14

PE

Answer 14

• HypoTN
• Tachycardia
• Hypoventilation
• UP temp
• Hypothermia
• Nuchal rigidity
• Head trauma evidence
• Nares purulent drainage
• TM
• Scleral Icterus
• Nasal septum erosion
• Skin

Question 15

Neuro Exam:

• level of consciousness
• Attention
• orientation
• memory
• perception
• thinking organization
• emotional

Answer 15

• level of consciousness= fluctuate
• Attention = poor/hallmark of delirium
• orientation = person, but not time and place
• memory = maybe
• perception = visual/auditory
• thinking organization = disordered
• emotional = lability

Question 16

Nocturnal confusion

Answer 16

Sundowning

Question 17

Neuro Exam red flags

Answer 17

• papilldema
• pupil changes
• ocular motility changes
• abnorm movement
• weakness

Question 18

Can ICP raise w/o Papilledema

Answer 18

Yes

Question 19

Weakness

Delirium + quadriparesis

Answer 19

• Central Pontine Myelinolysis
• Progressive multifocal leukoencephalopathy
• Acute disseminated encephalopalomyelitis

Question 20

Weakness
D
Delirium + Paraperesis

Answer 20

Cryptococcus
Vit b12 deficiency
ADEM

Question 21

Weakness

Proximal muscle weakness

Diff

Answer 21

Cushing’s

Question 22

Don’t do LP if suspect

Answer 22

Herniation

Question 23

DX approach:

Answer 23

• ABCs, Vitals
• Stable? = full neuro exam (ICP, focal s/s)
• Unstable? - urgent head CT
• Labs/EKG = metabolic/cardio/toxic cause
• CN infxn/SAH suspected? = LP
• Seizures? EEG
• Structural lesions w/ stable patient? MRI
• Last resort –> brain biopsy

Question 24

Suspect CNS vasculitis?

Answer 24

Brain biopsy

Question 25

Abnormal movements

Answer 25

``` Seizures Myclonus Asterixis (neg myoclonus) Tremor Gait Ataxia ```

Question 26

Ocular changes

Answer 26

= UP ICP/Brainstem dysfunction * upgaze palsy * unilateral impaired eye adduction + pupillary dilation + lowered consciousness = ER NEURO * unilateral 6th nerve palsy

Question 27

Inital labs

Answer 27

``` CBC w/ diff CMP Serum Ammonia Thryoid Blood gas Cardio enzyme UA drug screen Blood alcohol level ```

Question 28

IF LABS negative, consider these labs:

Answer 28

* HIV * Syphilis (rapid plasma reagin) * Thyroid (TSH/free T4) * Cortisol * Autoimmume (Anti-nuclear antibody)

Question 29

``` unilateral impaired eye adduction + pupillary dilation + lowered consciousness ```

Answer 29

ER Neuro EMERGENCY