Brain and Behavior: Systemic Metabolic Disorders

…: inflammation of brain parenchyma associated with clinical neurological dysfunction with CSF and/or parenchymal changes on imaging, direct infection, postinfectious, post immunization or non-infectious

encephalitis

…: encephalitis associated with meningeal inflammation

meningoencephalitis

…: disruption of brain function in the absence of direct inflammatory process in the parenchyma and associated with metabolic disturbances, hypoxia, drugs, organ dysfunction or systemic infection (MRI may not appear abnormal, EEG will)

encephalopathy

…: global cerebral dysfunction that accompanies many systemic problems, infections, metabolic disturbances, drug effects

toxic-metabolic encephalopathy

Clinical manifestations of toxic metabolic encephalopathy, range from mild disturbances to sever disturbance of arousal, characterized by …, asterixis or negative myoclonus

fluctuation in level arousal

…: a multisystem noncaseating granulomatous disorder of unknown etiology, uncommon to involve the nervous system in the absence of systemic disease

sarcoidosis

Clinical manifestations involve: … (4)

any part of the CNS/PNS, cranial neuropathy, chronic basal meningitis, uveitis

Neurosarcoidosis causes raised intracranial pressure with papilledema due to: … (3)

space-occupying lesions, diffuse meningeal involvement, hydrocephalus

Neurosarcoidosis causes meningoenphalitis which leads to: … (2)

cognitive, affective symptoms

Neurosarcoidosis with hypothalamic involvement causes: … (5)

hypopituitarism, diabetes insipidus, sleep disturbance, obesity, thermoregulatory disturbance

Neurosarcoidosis causes space-occupying lesions that cause: … (2)

seizures, focal deficits

Neurosarcoidosis leads to myelopathy resulting from …

infiltrating/focal granulomatous process

Neurosarcoidosis with peripheral nerve involvement manifests as: … (2)

distal polyneuropathy, mononeuropathy multiplex

Diagnostic tools of sarcoidosis: … (4)

histology, CSF with elevated proteins/lymphocytic pleocytosis, elevated serum ACE, MRI

Treatment of Neurosarcoidosis: … (3)

steroids, methotrexate, azathioprine

…: inflammatory connective tissue disorder of unknown etiology, predominantly affecting young women, clinical manifestations involve PNS/CNS

Systemic lupus erythematosus

Neuropsychiatric manifestations of systemic lupus erythematosus: … (2)

psychosis, affective disorders

Systemic lupus erythematosus causes: … (5)

APAs, hypercoagulability, headaches, seizures, distal symmetric sensory polyneuropathy, mononeuropathy multiplex

Diagnosis of systemic lupus erythematosus: … (3)

concurrent systemic manifestations, antinuclear antibodies, psychosis/depression (isolated CNS lupus)

immunosuppressant therapy in systemic lupus erythematosus depends on the severity of the disease, warranted for neurologic manifestations, usually patients are administered ....

corticosteroids with cyclophosphamides

Antiphospholipid antibody syndrome: elevated antibodies directed against phospholipids → … (3)

venous/arterial thrombosis, recurrent fetal loss, thrombocytopenia

Antiphospholipid antibody syndrome is demonstrated by: … (2)

solid-phase immunoassay, in-vitro prolongation partial thromboplastin time

Clinical manifestations of APAS: … (4)

venous thrombosis, brain arterial thrombosis, small/large vessel stroke, sneddon’s syndrome

Look for … in young patients with stroke

APAs

Treatment of APAS: … (2)

long-term anticoagulation, warfarin

Hyperthyroidism manifests with: … (6)

periodic paralyses, proximal myopathy, seizures, chorea, dysthyroid eye disease, myasthenia gravis

Hypothyroidism manifests as: … (7)

poor concentration, dementia, truncal ataxia, gait ataxia, proximal muscle cramps, entrapment neuropathy, axonal polyneuropathy

…: rare demyelinating disorder, often occurs in alcoholic patients

central pontine myelinolysis

Central pontine myelinolysis is precipitated by too rapid correction of …

hyponatremia

Regions affected by central pontine myelinolysis … > … > … > …

pons, basal ganglia, thalamus, subcortical white matter

Clinical manifestation of central pontine myelinolysis: … (5)

acute confusional state, spastic quadriparesis, locked-in syndrome, dysarthria, dysphagia

…: degeneration of the posterior and lateral white matter tracts of the spinal cord, initially paranesthesia develop in the hands and feet, subsequent weakness and spasticity develops in the legs

vit B12 deficiency

Alcohol and nutritional deficiencies may cause: … (5)

peripheral neuropathy, cerebellar degermation, wernicke’s encephalopathy, Korsakoff syndrome, tobacco-alcohol amblyopia

… and … are different stages of the same pathologic process

Wernicke’s encephalopathy, korsakoff syndrome

Wernicke’s encephaolpathy is characterized by the triad: …(3)

opthalmoplegia, ataxia, confusion

Associated signs and symptoms of wernicke’s encephopathy: … (4)

impaired pupillary light response, hypothermia, postural hypotension, nutritional deficiency

Peripheral neuropathy is diabetes mellitus: … (3)

distal symmetric sensory polyneuropathy, loss of temperature and pinprick sensations, small myelinated and unmyelinated fibers

Autonomic neuropathy in diabetes mellitus: … (5)

gustatory, sweating, orthostatic hypotension, diarrhea, impotence

Focal peripheral neuropathies in diabetes mellitus: … (4)

cranial neuropathies (III, IV, VI), median neuropathies, meralgia paresthetica, thoracic radiculopathy

…: pain in the quads at night which eventually atrophy, diabetic lumbosacral radiculoplexus neuropathy

diabetic amyotrophy