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Neurology

Question
21 out of 23
 

Which of the following is a cause of reversible dementia? (AIPG 2010)



A Subacute combined degeneration.

B Picks disease.

C Creutzfeldt - Jakob disease.

D Alzheimer's disease

Ans. A

Subacute combined degeneration.

Differential Diagnosis of Dementia:

Potentially Reversible dementia

1). Vitamin deficiencies

a. Thiamine (B1): Wernicke's encephalopathy

b. Nicotinic acid (pellagra)

c. B12 (pernicious anemia)

2). Endocrine and other organ failure

a. Hypothyroidism

b. Hypo-and hyperparathyroidism

c. Liver failure

d. Adrenal insufficiency and Cushing's syndrome

e. Renal failure

f. Pulmonary failure

3). Alcoholism

4). Psychiatric

a. Depression (pseudodementia)

b. Schizophrenia

5). Chronic Infections

a. Neurosyphilis

b. Tuberculosis, fungal, protozoal

c. Whipple’s disease

6). Head trauma and diffuse brain damage

a. Chronic subdural haemorrhage

b. Normal pressure hydrocephalus

7). Toxic disorders

a. Drug, medication, and narcotic poisoning

b. Heavy metal intoxication

Irreversible dementias

1). Alzheimer’s

2). Vascular dementia:

a. Multi infarct

b. Diffuse white matter disease (Binswanger's)

3). Parkinson’s disease

4). Degenerative

a. Huntington’s disease

b. Dementia with Lewy bodies

c. Multisystem degeneration

d. Cortical basal degeneration

e. Pick's disease

f. Progressive supranuclear palsy

g. Frontotemporal dementia

h. Multiple sclerosis

Table 371-4 Clinical Differentiation of the Major Dementias (Ref. Hari-18th ed., pg3303)

Disease

First Symptom

Mental Status

Neuropsychiatry

Neurology

Imaging

AD

Memory loss

Episodic memory loss

Initially normal

Initially normal

Entorhinal cortex and hippocampal atrophy

FTD

Apathy; poor judgment/insight, speech/language; hyperorality

Frontal/executive, language; spares drawing

Apathy, disinhibition, hyperorality, euphoria, depression

Due to PSP/CBD overlap; vertical gaze palsy, axial rigidity, dystonia, alien hand

Frontal and/or temporal atrophy; spares posterior parietal lobe

DLB

Visual hallucinations, REM sleep disorder, delirium, Capgras' syndrome, parkinsonism

Drawing and frontal/executive; spares memory; delirium prone

Visual hallucinations, depression, sleep disorder, delusions

Parkinsonism

Posterior parietal atrophy; hippocampi larger than in AD

CJD

Dementia, mood, anxiety, movement disorders

Variable, frontal/executive, focal cortical, memory

Depression, anxiety

Myoclonus, rigidity, parkinsonism

Cortical ribboning and basal ganglia or thalamus hyperintensity on diffusion/flare MRI

Vascular

Often but not always sudden; variable; apathy, falls, focal weakness

Frontal/executive, cognitive slowing; can spare memory

Apathy, delusions, anxiety

Usually motor slowing, spasticity; can be normal

Cortical and/or subcortical infarctions, confluent white matter disease

Note: AD - Alzheimer's disease; FTD - frontotemporal dementia; PSP - progressive supranuclear palsy; CBD - cortical basal degeneration; DLB - dementia with Lewy bodies; CJD - Creutzfeldt-Jakob disease.

Neurology Flashcard List

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