Neuro shelf - systemic and metabolic disorders

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

mononeuropathy multiplex, seizures, stroke

mononeuropathy multiplex, encephalopathy, stroke, chorea

headache, blindness, polyneuropathy, stroke

mononeuropathy multiplex, cranial neuropathy, basal meningitis

myelopathy

sensory polyneuropathy

aseptic meningoencephalitis

TIA, stroke, peripheral neuropathy

encephalopathy

encephalopathy, seizures, stroke

dementia, seizures, myoclonus, atazia, supranuclear ophthalmoplegia, oculomasticatory myorhythmia

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

• mitochondrial diseases
• myotonic dystrophy
• Friedrich ataxia
• stiff-man syndrome

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

proximal diabetic neuropathy

lethargy and drowsiness with focal or generalized seizures, sometimes dystonia of chorea

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

confusion and encephalopathy

dementia

seizures

ataxia

myelopathy

peripheral neuropathy

opthalmoplegia, truncal ataxia, confusion developing over days or weeks

may be precipitated by the administration of IV glucose

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)

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

• 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

periodic paralysis and proximal myopathy, seizures, chorea, and dysarthria, association with myasthenia gravis

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