kidney&cns
DESCRIPTION
GENERAL NEUROLOGYTRANSCRIPT
![Page 1: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/1.jpg)
NEUROLOGICAL DYSFUNCTION IN
UREMIA&DIALYSIS Dept. of neurology
![Page 2: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/2.jpg)
• UREMIC ENCEPHALOPATHY• UREMIC NEUROPATHY• OPTIC NEUROPATHYNEUROLOGICAL COMPLICATIONS OF DIALYSIS ENTRAPMENT NEUROPATHYISCHEMIC NEUROPATHYDIALYSIS DYSEQUILIBRIUM SYNDROMEWERNICKE’S ENCEPHALOPATHYDIALYSIS DEMENTIA
![Page 3: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/3.jpg)
UREMIC ENCEPHALOPATHY
COMA CAUSES HYPERTENSIVE ENCEPHALOPATHY PRES FLUID&ELECTROLYTE IMBALANCE SEPSIS SEIZURES DIALYSIS THIAMINE DEF. DRUG TOXICITY TRANSPLANT REJECTION
![Page 4: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/4.jpg)
PATHOPHYSIOLOGY
• PATHOLOGICAL CHANGES• METABOLIC CHANGES• UREMIC TOXINS• HORMONAL CHANGES
![Page 5: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/5.jpg)
CLINICAL FEATURES
• IMPAIRED EXTERNAL AWARENESS• CONCENTRATION• ATTENTION• ORIENTATION• EMOTIONAL &SLEEP CHANGES• MEMORY• OBTUNDATION • DELIRIUM• COMA
![Page 6: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/6.jpg)
CLINICAL FEATURES CONTD
• POSTURAL TREMOR• ASTERIXIS• MYOCLONUS• SEIZURES• PARATONIA• PRIMITIVE REFLEXES
![Page 7: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/7.jpg)
INVESTIGATIONS
• E/O RENAL DYSFUNCTION• CSF• EEG• IMAGING
![Page 8: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/8.jpg)
![Page 9: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/9.jpg)
![Page 10: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/10.jpg)
TREATMENT OF UREMIC CONVULSIONS
• DRUG LEVELS• PHENYTOIN• VALPROIC ACID• PHENOBARBITOL• LEVETIRACETAM,GABAPENTIN,TOPIRAMATE,
PREGABALIN
![Page 11: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/11.jpg)
UREMIC NEUROPATHY
• GFR<12ml/min-PERIPHERAL NERVE DYSFUNCTION
• GFR<6ml/min-CLINICAL DEFICITS
PATHOPHYSIOLOGY• MIDDLE MOLECULE THEORY• PARATHYROID HORMONE• UREMIC NEUROTOXIN CRITERIA• HYPERKALEMIA
![Page 12: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/12.jpg)
CLINICAL FEATURES
• LENGTH DEPENDENT, SYMMETYRIC ,MIXED SENSORY MOTOR POLY NEUROPATHY
• DYSESTHESIAS• MUSCLE CRAMPS• RESTLESS LEG • VIBRATION APPRECIATION• DTR• MOTOR WEAKNESS
![Page 13: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/13.jpg)
NEUROPATHY INVESTIGATIONS
• NERVE BIOPSY• NCS• EMG
![Page 14: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/14.jpg)
RESTLESS LEG SYNDROME
• WORST AT NIGHT&REST• LOW HB,HIGH PHOSPHOROUS• TREATMENT
![Page 15: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/15.jpg)
TREATMENT
• DIALYSIS• RENAL TRNSPLANTATION
![Page 16: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/16.jpg)
AUTONOMIC NEUROPATHY
• POSTURAL HYPOTENSION• IMPAIRED SWEATING• IMPOTENCE• GI DISTURBANCES
![Page 17: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/17.jpg)
OPTIC NEUROPATHY
• NEUROTOXIC• ISCHAEMIC• DRUGS • ICT
![Page 18: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/18.jpg)
NEUROLOGICAL COMPLICATIONS OF DIALYSIS
• MEMORY&ATTENTION• SUBDURAL HEMATOMA• MUSCLE CRAMPS,HEADACHE, NAUSEA,
VOMITINGS• CEREBROVASCULAR DISEASE
![Page 19: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/19.jpg)
![Page 20: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/20.jpg)
ENTRAPMENT NEUROPATHY
• CARPAL TUNNEL SYNDROME• ULNAR NERVE LESIONS
![Page 21: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/21.jpg)
![Page 22: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/22.jpg)
ISCHEMIC NEUROPATHY
• MILD –SENSORY• SEVERE-MOTOR&SENSORY• ISCHEMIC MONOMELIC NEUROPATHY
![Page 23: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/23.jpg)
DIALYSIS DYSEQILIRIUM SYNDROME
• HEADACHE• NAUSEA, ANOREXIA• MUSCLE CRAMPS• IRRITABILITY,RESTLESSNESS• AGITATION ,CONFUSION• COMA, SEIZURE• PAPILLEDEMA, RAISED ICP• EXOPHTHOLMOS, RAISED IOP
![Page 24: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/24.jpg)
• REVERSE UREA EFFECT• IDIOGENIC OSMOLESDIFFERENTIALSUREMIC ENCEPHALOPATHYINFECTIONHEMORRHAGECEREBRAL INFARCTIONHYPOGLYCEMIA, HYPONATREMIAMANAGEMENT
![Page 25: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/25.jpg)
WERNICK’S ENCEPHALOPATHY
• MALNUTRITION• TPN• INFECTIONS• RPT. INFUSIONS OF GLU., INSULINATAXIA, OPHTHALMOPLEGIA,CONFUSION
![Page 26: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/26.jpg)
DIALYSIS DEMENTIA
• CLINICAL FEATURES• ALUMINIUM CONTAMINATION• PHOSPHATE BINDERS• TAU PROTEIN
![Page 27: Kidney&Cns](https://reader035.vdocuments.mx/reader035/viewer/2022070313/554b5e6ab4c905e9388b5224/html5/thumbnails/27.jpg)
TREATMENT
• DIAZEPAM• DEFEROXAMINE