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Life Long Learning in Neurology - part 4

Một phụ nữ 48 tuổi với tiền sử cao huyết áp, xơ gan có cồn, dãn tĩnh mạch thực quản, và một số tập từ xa của chấn thương đầu đã được đưa đến phòng cấp cứu vì sự nhầm lẫn. Cô đã được bình thường trước đó trong ngày, nhưng trong bữa ăn tối, cô đã bắt đầu đưa ra nhận xét kỳ lạ và không liên quan | 55 30. A 48-year-old woman with a history of hypertension alcoholic cirrhosis esophageal varices and several remote episodes of head trauma was brought to the emergency department because of confusion. She had been normal earlier in the day but during supper she had started to make bizarre and irrelevant comments and her family said she just seemed out of it. She was afebrile. Her blood pressure was 150 90 mm Hg and her heart rate was 92 min. Her speech was fluent but tangential. At times she was able to answer complex questions and do twodigit subtraction in her head but at other times she acted as if she hadn t even heard the question. Her cranial nerves motor examination deep tendon reflexes and sensation were normal. A head CT scan showed a region of encephalomalacia in the right temporal lobe a lumbar puncture was normal except for a mildly elevated protein level and an EEG showed repetitive sharp-and-slow wave complexes at a frequency of 5 s in the right temporal lobe. Which of the following is the most likely diagnosis A. Hepatic encephalopathy B. Herpes simplex virus encephalitis C. Hypertensive encephalopathy D. Nonconvulsive status epilepticus E. Subdural hematoma Correct Answer The correct answer is D. The EEG features meet criteria for nonconvulsive status epilepticus. Her blood pressure is not high enough to cause hypertensive encephalopathy her examination and EEG show no features suggestive of hepatic encephalopathy her spinal fluid head CT and EEG show no features suggestive of herpes simplex virus encephalitis and her head CT shows no evidence of subdural hematoma. 31. Plateau waves A waves on an intracranial pressure tracing represent which of the following A. Decreased intracranial pressure B. Increased cerebral blood flow C. Increased cerebral blood volume D. Increased cerebral perfusion pressure E. Increased intracranial compliance Correct Answer The correct answer is C. Plateau waves A waves represent vasodilation in response to a decrease in