Diagnostic Tests for Amnesia
Amnesia Tests: Book Excerpts
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Amnesia Diagnosis: Book Excerpts
Diagnostic Tests for Amnesia: Online Medical Books
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AMNESIA:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
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
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
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:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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).
Testing
A. Clinical laboratory tests. These should include a complete blood count with differential, urinalysis, toxicology screen, serum chemistry panel, and appropriate medication levels. Vitamin B12 and folate levels, serologic test for syphilis, and thyroid function studies can be drawn. As clinically indicated, blood gases can also be checked. Based on history and examination, additional studies may include cerebrospinal fluid examination, heavy metals screen, and erythrocyte sedimentation rate (and others, as needed for vasculitis). An electroencephalogram (EEG) can be particularly useful in distinguishing delirium from psychiatric presentations—in delirium, the EEG will show diffuse slowing, except in cases of sedative drugs and withdrawal when low amplitude fast activity is seen; the EEG is normal in psychiatric syndromes.
B. Diagnostic imaging. Magnetic resonance imaging is indicated for first psychotic breaks, new onset of confusion after age 50 years, and in the presence of focal neurologic findings.
Diagnostic assessment
. Assume organic causes until proved otherwise. Delirium is more likely in those populations noted above, and is typically characterized by disorientation, a fluctuating symptom course, and alterations in the sleep–wake cycle. Paranoia may be seen. Be alert to the presence of visual hallucinations, which can suggest the possibility of delirium. A dementia history is typically one of long intellectual decline with usual levels of alertness and attention. Orientation is often impaired, as are recent and remote memory. Perceptual disturbances are often absent, unlike delirium (4). Acute psychoses caused by schizophrenia are often characterized by hallucinations, delusions, and formal thought disorder and do not typically include disorientation or altered levels of consciousness. Symptoms tend not to fluctuate and memory is intact. Psychoses that develop as part of major depression or mania follow the onset of affective symptoms. Conversion disorders can involve hallucinations in the absence of other psychotic symptoms. La belle indifference may be present, but no symptom fluctuation or sleep–wake alteration is seen. Dissociative states can include loss of memory, including personal data, and perhaps disorientation, but these are not embedded in other changes. Episodes are usually short and perceptual disturbances are rare. Anxiety-like symptoms may precede dissociation. Acute and posttraumatic symptoms follow traumatic events. Acute stress disorder, by definition, remits within 4 weeks, but has symptoms similar to posttraumatic stress disorder. Orientation is intact, concentration can be impaired, and increased vigilance may be present. Patients may seem detached or in a daze. Nightmares and flashbacks often occur but no perceptual disturbances or thought disorganization is seen. Memory is intact, except perhaps for the traumatic event. Signs of autonomic arousal may be seen, especially with recall of the event. EEG changes are absent in psychiatric disorders.
References
1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: American Psychiatric Association, 1994.
2. Folstein MF, Folstein SE, McHugh PR. The Folstein Mini-Mental State Examination: a practical method for grading the cognitive state of patients for the clinician. J Psychiatric Res 1975;12:189–198.
3. Inouye SK, vanDyck CH. Clarifying confusion: the confusion assessment method. Ann Intern Med 1990;113:941–946.
4. Lipowski ZJ. Delirium (acute confusional states). JAMA 1987;258:1789–1792.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Amnesia:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
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
Confusion:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
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: 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
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