Number connection test is done to detect:

Ans: D (Hepatic encephalopathy.) Ref: Davidson 21st edn and Harrison's Principles of Internal Medicine, 18th ednExplanation:HEPATIC ENCEPHALOPATHYIt is a neuropsychiatric syndrome caused by chronic liver disease.Due to disturbance of brain function by circulating neurotoxins metabolised by liver.Neurotoxins include:o Ammoniao GABAo Octopamineo Amino acidso Fatty acidso MercaptansPrecipitating Factorso Drugs like antidepressants, sedativeso High protein load in dieto Gi bleedingo Constipationo Hypokalemiao infectiono Dehydrationo Portosystemic shuntingClinical Featureso Altered sleep rhythm.o Asterixis.o Confusion and coma,o Fetor hepaticus.o Inability to perform simple sums,o Constructional apraxia (tested by drawing star or clock).o Rarely causes focal neurological deficit.o Focal signs if present are usually extensor piantars with hyperreflexia +.Number connection test used in assessing encephalopathy. The 25 numbered circles can normally be joined together within 30 seconds. Serial observations may provide useful information as long as the position of the numbers is varied to avoid the patient learning their pattern.EEG shows diffuse slowing of normal alpha waves and development of delta waves.Ammonia is elevated (nonspecific).Remove precipitant, reduce dietary proteins.Lactulose, osmotic laxative, oral neomycin.Rifaximin and Zinc supplementation.Liver transplant for chronic hepatic encephalopathy.Fig: Number connection test