Diagnosis of Wernicke-Korsakoff syndrome
Wernicke-Korsakoff syndrome Diagnosis: Book Excerpts
Diagnostic Tests for Wernicke-Korsakoff syndrome: Online Medical Books
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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.
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Source: Handbook of Signs & Symptoms (Third Edition), 2006
Alcohol-related disorder:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
For characteristic findings in patients with alcoholism, see Diagnosing substance dependence and related disorders, page 430.
Clinical findings may help support the diagnosis of alcohol-related disorder. For example, laboratory tests can confirm alcohol use and complications and document recent alcohol ingestion. A blood alcohol level ranging from 0.08% to 0.10% weight/volume (200 mg/dl) is accepted as the level of intoxication, depending on the state or country. The blood alcohol level in a physically dependent and tolerant drinker may exceed levels that would cause severe dysfunction or death in a nontolerant drinker. For example, a tolerant drinker might have a blood alcohol level of more than 0.5 mg (the usual lethal level) and still be alive, talking, and moving.
In severe hepatic disease, the blood urea nitrogen level is increased, and the serum glucose level is decreased. Further testing may reveal increased serum ammonia and amylase levels. Urine toxicology studies may help determine if the patient with alcohol withdrawal delirium or another acute complication abuses other drugs as well.
Liver function studies revealing increased levels of serum cholesterol, lactate dehydrogenase, alanine aminotransferase, aspartate aminotransferase, and creatine phosphokinase may point to liver damage, and elevated serum amylase and lipase levels point to acute pancreatitis. A hematologic workup can identify anemia, thrombocytopenia, increased prothrombin time, and increased partial thromboplastin time.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
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
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
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).
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Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Alcoholism:
Diagnosis
(Handbook of Diseases)
For characteristic findings in patients with alcoholism, see Diagnosing substance dependence and related disorders, page 286.
Laboratory values may help support the diagnosis of alcoholism — for example, they can confirm alcohol use and complications and indicate recent alcohol ingestion:
Blood alcohol level of 0.10% weight/volume (200 mg/dl) is accepted as the level of intoxication.
Blood urea nitrogen level rises in severe hepatic disease.
Blood glucose level is decreased.
Serum ammonia and amylase levels are increased.
Urine toxicology studies may help detect other types of drug abuse in patients with alcohol withdrawal delirium or another acute complication.
Liver function studies reveal increased levels of serum cholesterol, lactate dehydrogenase, alanine aminotransferase, aspartate aminotransferase, and creatine kinase (which indicate liver damage) and elevated serum amylase and lipase levels (which indicate acute pancreatitis).
Blood studies may identify anemia, thrombocytopenia, increased prothrombin time, and increased partial thromboplastin time.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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
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