Encephalopathy - CORRECT ANSWER Definition: Inability to carry out a coherent plan of
thought or
Action.
What mental status exam tests would you do in
... [Show More] an
encephalopathic patient? level of alertness, orientation, and attention
What test for encephalopathy? Vital signs and labs; Brain imaging can be normal but EEG shows
encephalopathy, EEG can be useful for testing encephalopathy because [1] can help to
differentiate neuro vs. psych; [2]. Rule out subclinical seizures or "non-convulsive status
epilepticus" (encephalopathy mimic)
Mimics of Encephalopathy include: Dementia with Lewy Bodies; REM sleep behavior disorder
(act out dreams) and parasomnias (sleepwalking); Wernicke's aphasia; Psychosis, mania,
depression; Nonconvulsive status epilepticus (last two: differentiate with EEG)
The hallmark of encephalopathy is: Impaired ATTENTION (early finding in delirium, late
finding in dementia)
Symptoms of encephalopathy include: Hallucinations, delusions, agitation or lethargy; Irritation
to light touch; Withdraw limbs unequally; Asterixis, myoclonus, tremor, sometimes
hyperreflexia (acute liver malfunction)/hyporeflexia (thyroid derangement)
T/F: Encephalopathy is often multifactorial: TRUE
Why does encephalopathy occur? Metabolic homeostasis imbalance
What can global disruption of metabolic homeostasis result in:
Behavior change, poor coordination, ataxia, confusion, seizures, stupor and coma; May be a lag
in recovery of CNS symptoms after the metabolic problem is corrected
Encephalopathy causes include:
VIITTAMIN: Vascular, Inflammatory, Infectious, Traumatic, Toxins, Autoimmune, Metabolic,
Idopathic/Genetic; Neoplastic
Vascular- Hypertensive encephalopathy
Inflammatory- Urinary tract infection in elderly; Infection of the
CNS (encephalitis)
Infectious- meningitis
Traumatic, Toxins,
Autoimmune,
Metabolic- endocrine disorders that cause
encephalopathy include:Hypo/hyperglycemia; Hypo/Hyperthyroidism
Idopathic/Genetic;
Neoplastic
The most likely electrolytes to cause metabolic
encephalopathy include: SODIUM (low and high) and CALCIUM (high)
Major nutritional deficiency that can cause
metabolic encephalopathy is: B12
Respiratory metabolic encephalopathy can be
caused by: High CO2, hypoxia
Organ failure that can cause metabolic
encephalopathy include: Uremia (kidney disease); Hyperammonia (liver disease)
Prescription meds that can cause toxic encephalopathy include: Overdose; Antibiotics
(ciprofloxacin); and anticholinergic drugs and sedating drugs (diphenhydramine- benadril,
lorazapam) in elderly
Wernicke's encephalopathy (Caused by alcohol, cancers, starvation and anorexia)Triad:
nystagmus, gait ataxia and confusion; Responds to thiamine replacement (GIVE THIAMINE
before glucose; thiamine is a cofactor for metabolism of carbs/sugars);
Wernicke-Korsakoff Syndrome: Prolonged thiamine deficiency; Chronic necrosis of
diencephalon (thalamus and hypothalamus),mammillary bodies, periventricular regions
ofbrainstem, anterior cerebellum; Anterograde amnesia with confabulation
Approach to diagnosis for altered mental status:
[1.] Identify the problem (history, exam);
[ 2.] Are there focal neuro findings? (If so--needs CT scan; If no--
need MRI);
[3.] If not do toxic-metabolic workup
Toxic metabolic workup includes:
ABC's (vital signs, BP, Fever); Complete blood count;
Basic metabolic profile (electrolytes, kidney function,
glucose); Tox screen; Liver function tests Head and brain trauma and injury
How to treat encephalopathy:
IDENTIFY CAUSE!
Thiamine with glucose (GIVE THIAMINE before glucose😉
Narcan/Naloxone for opiate overdose;
Hydration, electrolytes;
Antipsychotics used off-label (controversial);Brain function "lags behind" labs
What mental status exam tests would you do in an
encephalopathic patient? - CORRECT ANSWER level of alertness, orientation, and attention
What test for encephalopathy? - CORRECT ANSWER Vital signs and labs; Brain imaging can
be normal but EEG shows encephalopathy, [Show Less]