Diagnosis of Amnesia
Amnesia Diagnosis: Book Excerpts
Diagnostic Tests for Amnesia: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about diagnostis of Amnesia.
AMNESIA:
Ask the following questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is the amnesia transient or persistent? If it is transient, one should look for evidence of a head injury. If there is no evidence of a head injury, then one should consider epilepsy, transient ischemic attacks, and migraine. If there is evidence of a
head
injury, one would consider concussion and some of the other more serious conditions of the brain that occur with a head injury.
- Is there a fever? If the amnesia is persistent and there is a fever, one needs to consider encephalitis, meningoencephalitis, cerebral abscesses, and encephalomyelitis. If there is no fever, one must ask if there is a reduction of memory for recent events. If there is reduction of memory for recent events, one should consider some of the more serious diseases of the brain, such as cerebral tumors, chronic drug or alcohol use, Alzheimer's disease, cerebral arterial sclerosis, and neurosyphilis. If there is no reduction of memory for recent events, then a psychiatric disorder such as hysteria, dissociated reaction, or schizophrenia must be considered.
DIAGNOSTIC WORKUP
All patients with a history of amnesia deserve a CT scan or magnetic resonance imaging (MRI). The CT scan would be more cost-effective and would be the diagnostic test of choice because it also helps detect acute brain hemorrhages. Patients with fever should have a spinal tap as well as CBC, urinalysis, and chemistry panel. These patients also probably should have a blood culture. An electroencephalogram (EEG) should be ordered to rule out epilepsy and toxic metabolic inflammatory diseases of the brain.
If all these studies are negative and an organic cause is still considered, then referral to a neurosurgeon or neurologist is in order. If these studies are negative and a psychiatric disorder is suspected, a psychiatrist should be consulted.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Amnesia:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Head trauma (e.g., concussion, hemorrhage)
–Usually results in transient retrograde and anterograde amnesia
Alzheimer's disease
–Most common cause of chronic amnesia
Infection
–Herpes simplex encephalitis is a particularly common cause of infectious amnesia, because it has a predilection for the temporal lobes
- Seizure disorders
–Retrograde amnesia is most common after a generalized tonic-clonic seizure during the postictal period
–Some complex partial seizure foci (particularly temporal lobe epilepsy) can also produce “blank” periods of memory
-
Toxicologic insults
–Binge alcohol consumption
–Benzodiazepine use (e.g., “date rape” drug
flunitrazepam, also known as Rohypnol)
-
Psychogenic causes are relatively common, but should be a diagnosis of exclusion
-
Korsakoff's syndrome
-
Transient global amnesia
–A rare, transient, ischemic attack-like condition of proposed vascular etiology
–Causes abrupt onset of short-term memory
loss for minutes to hours
–Typically occurs in patients older than 50
–Seen in patients with migraines
Workup and Diagnosis
-
History and physical examination
–Special attention to neurologic and head examination
–Life-threatening head trauma and CNS infection should
be considered initially in patients with altered mental status and amnesia
Initial labs may include CBC, electrolytes, glucose, calcium, magnesium, phosphorus, coagulation studies, and serum and urine toxicology screens Lumbar puncture with CSF analysis should be considered early if CNS infection is suspected
–Test for opening pressure, appearance (e.g., clear, cloudy, bloody), protein, glucose, CSF-to-serum glucose ratio, Gram stain, culture
–Cryptococcal antigen and acid-fast bacilli smear and culture in patients in endemic areas or with HIV
–If there is a delay in initiating lumbar puncture due to a need for imaging (e.g., head CT to rule out increased intracranial pressure), empiric antibiotics should be administered immediately
-
Head CT without contrast may be needed to exclude bleeding in cases of head trauma, and may also identify structural lesions
-
MRI of the head with diffusion-weighted imaging is more sensitive for diagnosing stroke, tumor, and the subtle white matter changes associated with vascular disease
-
EEG to rule out seizure disorder
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
AMNESIA:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The workup of amnesia must include a drug screen, CT scan, or magnetic resonance imaging (MRI) and often an electroencephalogram (EEG) to rule out epilepsy. Migraine may ruled out by a careful history. A neurologist or psychiatrist will need to be consulted in most cases. If there is fever, a CBC, chemistry panel, ANA, urinalysis, and blood cultures should be ordered. A spinal tap may be necessary as well.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Confusion:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
When you take his history, ask the patient to describe what's bothering him. He may not report confusion as his chief complaint, but may suffer from memory loss, persistent apprehension, or the inability to concentrate. He may be unable to respond logically to direct questions. Check with a family member or friend about its onset and frequency. Find out, too, if the patient has a history of head trauma or a cardiopulmonary, metabolic, cerebrovascular, or neurologic disorder. Which medications is he taking, if any? Ask about any changes in eating or sleeping habits and in drug or alcohol use.
Perform an assessment to determine the presence of systemic disorders. Check the patient's vital signs, and assess him for changes in blood pressure, temperature, and pulse.
Next, perform a neurologic assessment to establish the patient's level of consciousness.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Amnesia:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Because the patient typically isn’t aware of his amnesia, you’ll usually need help in gathering information from his family or friends. Throughout your assessment, notice the patient’s general appearance, behavior, mood, and train of thought. Ask when the amnesia first appeared and what types of things the patient is unable to remember. Can he learn new information? How long does he remember it? Does the amnesia encompass a recent or remote period?
Test the patient’s recent memory by asking him to identify and repeat three items. Retest after 3 minutes. Test his intermediate memory by asking, “Who was the president before this one?” and “What was the last type of car you bought?” Test remote memory with such questions as “How old are you?” and “Where were you born?”
Take the patient’s vital signs and assess his level of consciousness (LOC). Check his pupils: They should be equal in size and should constrict quickly when exposed to direct light. Also, assess his extraocular movements. Test motor function by having the patient move his arms and legs through their range of motion. Evaluate sensory function with pinpricks on the patient’s skin. (See Amnesia: Common causes and associated findings.)
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Alzheimer's disease:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Early diagnosis of Alzheimer’s disease is difficult because the patient’s signs and symptoms are subtle. (See Organic brain syndrome, page 662.) Diagnosis relies on an accurate history from a reliable family member, mental status and neurologic examinations, and psychometric testing. A positron emission tomography scan measures the metabolic activity of the cerebral cortex and may help in early diagnosis. An EEG and a computed tomography scan may help in later diagnosis. Currently, the disease is diagnosed by exclusion; that is, tests are performed to rule out other disorders. The presence of Alzheimer’s can’t be confirmed until death, when pathologic findings are revealed at autopsy.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Dissociative amnesia:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
For characteristic findings in patients with this condition, see Diagnosing dissociative amnesia.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Confusion:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
When you take his history, ask the patient to describe what’s bothering him. He may not report confusion as his chief complaint but may complain of memory loss, persistent apprehension, or the inability to concentrate. He may be unable to respond logically to direct questions. Check with a family member or friend about the onset and frequency of the patient’s confusion. Find out, too, if the patient has a history of head trauma or a cardiopulmonary, metabolic, cerebrovascular, or neurologic disorder. Which medications is he taking, if any? Ask about any changes in eating or sleeping habits and in drug or alcohol use.
Perform an assessment to determine the presence of systemic disorders. Check vital signs, and assess the patient for changes in blood pressure, temperature, and pulse.
Next, perform a neurologic assessment to establish the patient’s level of consciousness.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Amnesia:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Because the patient often isn’t aware of his amnesia, you’ll usually need help in gathering information from his family or friends. Throughout your assessment, notice the patient’s general appearance, behavior, mood, and train of thought. Ask when the amnesia first appeared and what types of things the patient is unable to remember. Can he learn new information? How long does he remember it? Does the amnesia encompass a recent or a remote period?
Test the patient’s recent memory by asking him to identify and repeat three items. Retest him after 3 minutes. Test his intermediate memory by asking, “Who was the president before this one?” and “What was the last type of car you bought?” Test remote memory with such questions as “How old are you?” and “Where were you born?”
Take the patient’s vital signs and assess his level of consciousness (LOC). Check his pupils: They should be equal in size and should constrict quickly when exposed to direct light. Also, assess his extraocular movements. Test motor function by having the patient move his arms and legs through their range of motion. Evaluate sensory function with pinpricks on the patient’s skin. (See Amnesia: Causes and associated findings.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Confusion:
History
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
. Collateral information is valuable with confused patients.
A. Characteristics. Is there an altered level of consciousness? Is so, consider urgent factors. Is the patient easily distractible or having difficulty keeping track of what is said? Is there an altered sleep–wake cycle; do symptoms fluctuate and are there changes in psychomotor behavior? If so, delirium is likely. Is thinking disorganized or incoherent? Is speech rambling, irrelevant, or frequently switching subjects? Is the patient disoriented? Do memory problems exist? Are there perceptual disturbances, including hallucinations or thought broadcasting, insertion, or withdrawal? The presence of visual hallucinations suggests organic causes. Are delusions present? Is there an indifference to the symptoms? If so, consider conversion disorder. Are there nightmares or increased startle response? If so, acute or posttraumatic stress disorders should be considered (Chapter 3.1).
B. Chronology of symptoms. Is the onset acute? In dementia, a chronic degree of confusion exists; however, acute confusion can herald the onset of delirium, warranting further evaluation (Chapter 4.1). Is the course fluctuating and do symptoms occur more often at night? If so, this suggests delirium. Have such symptoms occurred in the past? If so, what caused them then?
C. Medical history. Confusion is more likely in patients with multiple medical problems, longer lists of medications, or recent medication changes. Medications that can induce confusion include anticholinergics, sedatives, steroids, metronidazole, and digoxin, among others.
D. Psychiatric history. Are there any prior diagnoses and treatments, or a psychotropic medication history? If so, do current symptoms match prior psychiatric episodes? If so, consider a psychiatric recurrence. Have there been any recent psychosocial stressors? If so, consider the possibilities of dissociative and stress syndromes. It is important to note that a prior psychiatric history does not necessarily imply the confusion is caused by a psychiatric exacerbation; conversely, the absence of a psychiatric history does not rule out a psychiatric cause. Psychotic disorders tend to occur in younger patients, whereas delirium is more likely in older patients.
E. Other information. Current or past use of alcohol or drugs, recent injuries (particularly head injuries), and exposure to toxins. A review of systems helps detect organic causes.
Physical examination
A. Focused physical examination. This should include vital signs, psychomotor characteristics, assessment of skin, hair, and nail beds; and
a funduscopic examination. A screening neurologic examination should include a check for nuchal rigidity, and an assessment of Kernig’s and Brudzinski’s signs. Positive findings warrant further testing. The Folstein Mini-Mental State examination (2) can help assess cognitive functioning (Chapter 4.5). The Confusion Assessment Method may be used to help detect delirium (3).
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Amnesia:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Concussion
❑ Alzheimer disease
❑ Drugs
❑ Generalized seizure
❑ Migraine
❑ Transient global amnesia
❑ Psychogenic
❑ Herpes simplex encephalitis
❑ Complex partial seizures
❑ Korsakoff syndrome
Diagnostic Approach
Amnesia is characterized by an inability to recall prior events and to learn new information, despite a normal level of consciousness. There must be injury to both temporal lobes in order for amnesia to occur.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Alzheimer's disease:
Diagnosis
(Handbook of Diseases)
Early diagnosis of Alzheimer’s disease is difficult because the patient’s signs and symptoms are subtle. The diagnosis is based on an accurate history from a reliable family member, mental status and neurologic examinations, and psychometric testing. Symptoms and history are compared with the criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition – Text Revision.
A positron emission tomography scan measures the metabolic activity of the cerebral cortex and may help in reaching an early diagnosis. An EEG and a computed tomography scan may help in later diagnosis.
The disease is essentially diagnosed by exclusion: Various tests are performed to rule out other disorders. Ultimately, however, the disease can’t be confirmed until death, when an autopsy reveals pathologic findings.
CLINICAL TIP: Many researchers believe that the aluminum and silicon found in neurofibrillary tangles and neuritic plaques occurs as a result of damage and isn’t a cause.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Confusion:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
When you take his history, ask the patient to describe what’s bothering him. He may not report confusion as his chief complaint but may complain of memory loss, persistent apprehension, or the inability to concentrate. He may be unable to respond logically to direct questions. Check with a family member or friend about onset and frequency. Find out, too, if the patient has a history of head trauma or a cardiopulmonary, metabolic, cerebrovascular, or neurologic disorder. Find out which medications he’s taking, if any. Ask about any changes in eating or sleeping habits and in drug or alcohol use.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Confusion:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
When you take his history, ask the patient to describe what's bothering him. He may not report confusion as his chief complaint, but may suffer from memory loss, persistent apprehension, or the inability to concentrate. He may be unable to respond logically to direct questions. Check with a family member or friend about its onset and frequency. Find out, too, if the patient has a history of head trauma or a cardiopulmonary, metabolic, cerebrovascular, or neurologic disorder. Which medications is he taking, if any? Ask about any changes in eating or sleeping habits and in drug or alcohol use.
Perform an assessment to determine the presence of systemic disorders. Check the patient's vital signs, and assess him for changes in blood pressure, temperature, and pulse.
Next, perform a neurologic assessment to establish the patient's level of consciousness.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Amnesia:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Because the patient typically isn't aware of his amnesia, you'll usually need help in gathering information from his family and friends. Throughout your assessment, notice the patient's general appearance, behavior, mood, and train of thought. Ask when the amnesia first appeared and what the patient is unable to remember. Can he learn new information? How long does he remember it? Does the amnesia encompass a recent or remote period?
Test the patient's recent memory by asking him to identify and repeat three items. Retest after 3 minutes. Test his intermediate memory by asking, “Who was the president before this one?” and “What was the last type of car you bought?” Test remote memory with such questions as “How old are you?” and “Where were you born?”
Take the patient's vital signs and assess his level of consciousness (LOC). Check his pupils: They should be equal in size and should constrict quickly when exposed to direct light. Assess his extraocular movements. Test motor function by having the patient move his arms and legs through their range of motion. Evaluate sensory function with pinpricks on the patient's skin.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
AMNESIA:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The workup of amnesia must include a drug screen, CT scan, or magnetic
resonance imaging (MRI) and often an electroencephalogram (EEG) to rule out
epilepsy. Migraine may be ruled out by a careful history. A neurologist or
psychiatrist will need to be consulted in most cases. If there is fever, a
CBC, chemistry panel, antinuclear antibody (ANA), urinalysis, and blood
cultures should be ordered. A spinal tap may be necessary as well.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
The father of television personality Linda Dano experienced years of mental deterioration before he was diagnosed with Alzheimer's disease. Hear...
People with early-stage Alzheimer's disease know that they will have trouble remembering things. But there are a variety of techniques that can...
Allen Willner was diagnosed with Alzheimer's disease early in the disease process. With medication and the care of his wife, he's slowing the...
People with early Alzheimer's disease know that the condition gets progressively worse over time. Learn how some medications help to stabilize...
See full list of 9 related videos
» Next page: Signs of Amnesia
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
