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Altered Mental Status
I WATCH DEATH
UNABLE TO STAND
Nutritional deficiency (vit B12)
Other (rare metabolic, genetic)
Toxins (drugs, toluene, mercury)
Demyelination (Miller Fisher, Guillain Barre, MS)
Trauma (post concussive)
Toxins (drugs, toluene, alcohol)
What is a postive Romberg sign? What does it indicate?
The inability to balance with eyes closed. It indicates problems with proprioception.
Cerebellar vs. sensory ataxia
See more dysdiadochokinesia and dysmetria with cerebellar. Also hypotonia. Unilateral suggests a focal lesion, bilateral is more likely due to diffuse causes
(drug, alcohol, paraneoplastic)
See more sensory, proprioceptive, and vibratory deficits with sensory.
(Vit B12 def, tabes dorsalis)
Metabolic diseases presenting with recurrent or progressive ataxias
maple syrup urine disease,
G, I'M LIMP, CAN'T STAND
Iatrogenic (paralytics, aminoglycosides, steroids)
Lou Gehrig's disease (ALS, motor neuron disease, usually gradual)
Infection (Polio, botulism)
Periodic paralysis, porphyria, paraproteinemia
Toxins (lead, arsenic, pufferfish, tick paralysis)
Systemic illness (anemia)
Neuromuscular junction disease
I CONVULSE BIG TIME
Lytes (hypoNa, hypoMg, hypoCa)
Inborn error of metabolism
Things to include in the history-taking of a seizure
focal motor activity during the sz
was the motor activity rhythmic and synchronous
the presence and direction of eye deviation
was he able to respond to verbal stimulus
post ictal? for how long?
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