Page 1 of 2: Neurology,Medicine.

cingulate_gyrus2006 · Credits: 22790 My Scrapbook

1. Vishual hallucination are important feature of.
a. Alzheimer's dementia.
b. Dementia of Lewy Bodies.
c. Normal pressure hydrocephalus.
d. Pick's disease.

parin · Credits: 14470 My Scrapbook My Reading List 1 Books

See Harrison's.. approach to patient with dementia.. the diagnosis of DLB is suggested by the early presence of visual hallucinations, parkinsonism, delirium & REM sleep disorder-merging of dream states into wakefulness & Capgras syndrome- the delusion of imposters..

So the answer should be Dementia with Lewy Bodies..

cingulate_gyrus2006 · Credits: 22790 My Scrapbook

Yes right .
Presence of early visual halucination along with parkinsonian sign is characteristic of dementia of lewy bodies..

cingulate_gyrus2006 · Credits: 22790 My Scrapbook

Here is the notes from harrison..

DEMENTIA WITH LEWY BODIES

This syndrome is characterized by visual hallucinations, parkinsonism, fluctuating alertness, and falls. Dementia can precede or follow the appearance of parkinsonism. DLB34 may present in a patient with longstanding Parkinson's disease without cognitive impairment who slowly develops dementia associated with visual hallucinations, parkinsonism, and fluctuating alertness. In other patients the dementia and neuropsychiatric syndrome precede the parkinsonism. DLB patients are highly susceptible to metabolic perturbations, and in some the first manifestation of illness is a delirium, often precipitated by an infection or other systemic disturbance. A delirium induced by L-dopa, prescribed for parkinsonian symptoms attributed to Parkinson's disease, may be the initial clue that the correct diagnosis is DLB. Even without an underlying precipitant, fluctuations can be marked in DLB patients, with the occurrence of episodic confusion admixed with lucid intervals. However, despite the fluctuating pattern, the clinical features persist over a long period of time, unlike delirium, which resolves following correction of the underlying precipitant. Cognitively, DLB patients tend to have relatively better memory, but more severe visuospatial deficits, than individuals with AD1.

The key neuropathologic feature is the presence of Lewy bodies throughout the cortex, amygdala, cingulated cortex, and substantia nigra. Lewy bodies are intraneuronal cytoplasmic inclusions that stain with periodic acid-Schiff (PAS) and ubiquitin. They are composed of straight neurofilaments 7 to 20 nm long with surrounding amorphous material. They are recognized by antibodies against phosphorylated and nonphosphorylated neurofilament proteins, ubiquitin, and a presynaptic protein called a-synuclein. Lewy bodies are traditionally found in the substantia nigra of patients with idiopathic Parkinson's disease. A profound cholinergic deficit is present in many patients with DLB35 and may be a factor responsible for the fluctuations and visual hallucinations present in these patients. In patients without other pathologic features, the condition is referred to as diffuse Lewy body disease. In patients whose brains also contain excessive amounts of amyloid plaques and NFTs20, the condition is called the Lewy body variant of AD1. The quantity of Lewy bodies required to establish the diagnosis is not agreed on, but a definite diagnosis requires pathologic confirmation. At autopsy, 10 to 30% of demented patients show cortical Lewy bodies.

Due to the overlap with AD1 and the cholinergic deficit in DLB36, anticholinesterase compounds may be helpful. Exercise programs are also helpful to maximize the motor function of these patients. Antidepressants are often necessary to treat depressive syndromes that accompany DLB. Atypical antipsychotics in low doses are sometimes needed to alleviate psychosis, although even low doses can increase extrapyramidal syndromes, which rarely may be life-threatening. As noted above, patients with DLB are extremely sensitive to dopaminergic medications, which must be carefully titrated; tolerability may be improved by concomitant use of cholinesterase inhibitors.

svbyzma · Credits: 990 My Scrapbook

A Differential Diagnosis of Visual Hallucinations, especially in the elderly, is something worth remembering. Besides Lewy Body Dementia, visual hallucinations are also seen in fronto-temporal dementia, multi-infarct dementia and the later stages of Alzheimer's disease.
Another common cause is delirium of any etiology. In the elderly, drugs should always be kept in mind as a common cause of delirium e.g. digoxin, cimetidine, beta-blockers etc.
Charles Bonnet Syndrome is a condition in which visual hallucinations occur against a background of visual impairment without any other psychiatric symptoms.
Delirium Tremens is also a cause.
Schizophrenia could also be mentioned but here the hallucinations are mainly auditory.
Finally, substance abuse should also be kept in mind especially in the younger age group.

Shahrukh.

parin · Credits: 14470 My Scrapbook My Reading List 1 Books

nice post svbyzma..

svbyzma · Credits: 990 My Scrapbook

Dear Parin,
Thanks for your encouragement.
I have here with me a list of drugs that could cause visual hallucinations.
I shall enumerate a few which I think would be of importance:
Tricyclic Antidepressants
Meperidine
Narcotics
Propranolol & other Beta-Blockers
Qunine
Pentazocine (Fortwin)Primidone
Phenytoin
Oxyphenbutazone
Indomethacin
Chloroquine & Hydroxychloroquine
Levodopa
Isosorbide
Haloperidol
Digoxin-Digitalis
Carbamazepine
Benzodiazepines
Atropine-like drugs
Amantadine
Antihistaminics

Shahrukh.

parin · Credits: 14470 My Scrapbook My Reading List 1 Books

Dear svbyzma.. useful post again!!

bksnitin · Credits: 611 My Scrapbook

thats nice discussion...

tiptopgoodstuff · Credits: 200 My Scrapbook

Thank you

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