Signs and Symptoms in Psychiatry
Mohamed Ahmed Abd El-Hay in Essentials of Psychiatric Assessment, 2018
Eye examination: Edema of the conjunctiva and eyelids may result from local eye diseases (usually unilateral) or congestive heart failure (usually bilateral).Scleral icterus: yellowish discoloration of the sclera usually denotes hyperbilirubinemia.Kayser–Fleischer rings in cases of Wilson disease.Papilledema in cases of increased intracranial pressure.Subhyaloid hemorrhages in subarachnoid hemorrhage.
Paediatrics
Seema Khan in Get Through, 2020
For each case below, choose the SINGLE most appropriate management option from the list of options. Each option may be used once, more than once or not at all. A 2-year-old girl presents with failure to thrive and diarrhoea. She is found to have iron-deficiency anaemia. Small bowel biopsy shows flattened villi, elongated crypts and loss of columnar cells.A 12-year-old boy is being treated for osteomyelitis. He has been on intravenous antibiotics for 2 weeks. He now has diarrhoea. On sigmoidoscopy there are multiple, patchy, yellowish areas of necrotic mucosa.A 6-month-old baby boy presents with repeated bouts of vomiting and abdominal distension. He is normal between attacks. A sausage-shaped mass is palpated in his abdomen.A 2-month-old baby girl presents with failure to thrive. She has frequent episodes of vomiting with abdominal distension. Abdominal radiograph shows proximal bowel dilatation and no faeces or gas in the rectum.A 12-year-old boy presents with liver disease. A slit-lamp examination reveals Kayser – Fleischer rings in his cornea. Urinary copper level is high.
EMI – neuropsychiatry
Bhaskar Punukollu, Michael Phelan, Anish Unadkat in MRCPsych Part 1 In a Box, 2019
3. F. Kayser–Fleischer ring: (copper deposits in the cornea) is nearly always present in patients who have developed neurological symptoms in Wilson’s disease. In Wilson’s disease an enzyme defect in a copper transport molecule leads to toxic levels of free copper in the serum and copper deposits in CNS, liver, kidneys and bones. The adult form of Wilson’s disease presents with progressive neurological and psychiatric symptoms. Tests: ceruloplasmin (decreased), free serum copper (increased), urine 24-hour copper increased, liver biopsy, slit lamp exam.
A review and update on the diagnosis and treatment of neuropsychiatric Wilson disease
Published in Expert Review of Neurotherapeutics, 2019
Sean Cleymaet, Katsuko Nagayoshi, Edward Gettings, Justin Faden
WD presents pleiotropically and can be an easily missed diagnosis. This especially applies for patients with neuropsychiatric symptoms that may not have been screened for hepatic dysfunction. Initial workup consists of a serum ceruloplasmin level and a 24-hour urinary copper test, in addition to labs such as a complete blood count (CBC), basic metabolic panel (BMP), and hepatic function panel. A slit-lamp examination for Kayser-Fleischer rings is often added. Use caution when interpreting laboratory results; ceruloplasmin and urinary copper levels are affected by acute infection, hepatic injury, renal failure, and certain medications such as steroids and estrogens [44]. In these cases, additional testing such as liver biopsy (with copper quantitation) and genetic analysis (for ATP7B mutations) is indicated. To increase diagnostic accuracy a number of different scoring systems have been proposed. The most well-known was developed during the 8th International Meeting on WD held in Leipzig (2001) and is adapted below (Table 1) [46].
Brain microstructural changes and cognitive function in non-demented essential tremor patients: a diffusion tensor imaging study
Published in International Journal of Neuroscience, 2021
Y. Sengul, H. O. Temur, Z. Corakcı, H. S. Sengul, H. Dowd, I. Ustun, A. Alkan, E. D. Louis
We recruited 81 consecutive patients with tremor between 18 and 76 years old who visited the general or movement disorders clinic of the Neurology Department of the Bezmialem Foundation University Hospital, Eyup Sultan, and Fatih Additional Buildings in Istanbul, Turkey, during the six-month period between January 2018 and July 2018. The study was conducted according to the ethical principles stated in the Declaration of Helsinki and was approved by the Ethical Committee of the Bezmialem Foundation University Hospital. Written informed consent was obtained from the participants after the nature of the procedures had been fully explained. Sociodemographic characteristics, family history (first- and second-degree), and duration of disease were recorded. We ruled out other possible causes of tremor using the following blood tests: thyroid hormone, vitamin B12, folate, other biochemical blood tests (e.g. liver and kidney functions), and hemogram. An ophthalmologist examined patients for Kayser-Fleischer rings in those younger than 45 years.
Hyperglycemic hemichorea due to diabetic striatopathy: case-based review
Published in Current Medical Research and Opinion, 2022
Mihael Emilov Tsalta-Mladenov, Darina Kirilova Georgieva, Silva Peteva Andonova
On admission, the patient presented in good general condition, well oriented, in an afebrile state − 36.7 °C, the regular pulse at 76 beats per minute, and blood pressure 120/75 mm/Hg. The neurological examination revealed bilaterally equal pupils reactive to light and no Kayser-Fleischer ring was appreciated on naked eye examination. All cranial nerves were intact. The motor activity examination presented with preserved muscle strength 5/5 for all limbs, slightly decreased muscle tone for the left upper and lower limb, involuntary hyperkinetic movements for the left limbs and the left half of the face, described as hemichorea. Deep tendon reflexes were normal for the upper limbs and decreased, just elicitable (−3) patellar and Achilles reflexes bilaterally. There were no pathological reflexes from Babinski and Rossolimo groups. The superficial and deep sensation was preserved, and there were no cerebellar signs, whereas the gait was abnormal due to the hyperkinetic dance-like movements. Higher mental functions and all other systemic examinations were within the normal limits.
Related Knowledge Centers
- Cornea
- Eye
- Copper
- Descemet'S Membrane
- Ophthalmology
- Sclera
- Wilson's Disease
- Basal Ganglia
- Brain
- Cirrhosis