...
Is there a history of drug or alcohol ingestion? Chronic barbiturate intoxication, ergotism, and other psychotropic or antidepressant drugs may cause dementia. Alcoholism may cause dementia in the form of Korsakoff's psychosis or ... DIAGNOSTIC WORKUP
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...
Is there a history of drug or alcohol ingestion? Hallucinations are common during alcohol withdrawal but also may be noted in cocaine addiction, marijuana addiction, LSD intoxication, and PCP intoxication.
Are the ... DIAGNOSTIC WORKUP
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...
Are there convulsive movements or incontinence? The presence of convulsive movements should suggest convulsions, and the differential diagnosis of this is discussed on
page 88
.
... DIAGNOSTIC WORKUP
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...
Is there associated fever? Delirium with fever may simply indicate a self-limited infectious process, but it should bring to mind encephalitis and meningitis as well as cerebral abscess and cerebral ... DIAGNOSTIC WORKUP
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...
Dementia is a syndrome of premature neuronal death in focal brain regions. More than 50 illnesses may cause dementia. It affects 1% of the population by age 60, and this prevalence doubles every 5 years to reach 30–50% by age 85. Common findings include aphasia (language disorder... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Hallucinations are psychotic symptoms in which patients perceive stimuli that do not exist. Any of the five senses (auditory, visual, tactile, gustatory, or olfactory) may be involved, with auditory hallucinations being the most common.... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Syncope is often referred to by patients as “fainting” and is defined as a loss of postural tone and consciousness. Syncope usually lasts for brief periods of a few minutes. Longer periods are of more concern, because of the possibility of major cardiac or neurologic problems. The... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
An acute confusional state caused by a disturbance in global cortical function. Features include disturbance of consciousness, change in cognition, fluctuations of symptoms, and evidence that the condition is secondary to an underlying medical condition. Frequently, multiple... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Hallucinations are defined as perceptual experiences that do not occur in reality. They may be auditory (most common), visual, tactile, or olfactory.
Differential Diagnosis
... Workup and Diagnosis ... Treatment
... READ EXCERPTS »
...
Syncope is temporary loss of consciousness and muscle tone due to decreased cerebral blood flow. It is otherwise known as fainting or blackout. Syncope is a common pediatric problem that, in contrast to that in adults, usually has a benign etiology. However, it can be a... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Delirium is an alteration in consciousness that can be associated with hallucinations, disorientation, and delusions. Normal thought processes are altered, including judgment, and rational behavior may be lost. Causes are typically metabolic derangements, acute infections, or... Differential Diagnosis ... Workup and Diagnosis ... Treatment
... READ EXCERPTS »
... A hallucination is seeing, hearing, touching, smelling, or tasting something that is not there. Auditory hallucinations without evidence of mental deterioration usually indicate schizophrenia, but epilepsy, drug toxicity, and brain tumors must be excluded. Visual hallucinations are
... READ EXCERPTS »
... The differential of syncope or a brief loss of consciousness is best developed with the use of physiology and, to a lesser extent, anatomy. Like convulsions (see page 128), syncope is due to a diminished supply of oxygen and glucose in the brain cell. Anything that produces
... READ EXCERPTS »
... The differential diagnosis of delirium is very similar to that for coma and one finds the mnemonic VINDICATE useful in this regard.
V—Vascular disorders of the brain including hemorrhage, embolism, thrombosis, and
... READ EXCERPTS »
... Memory loss is a real symptom and sign, but organic brain syndrome should be dropped from usage because it is a wastebasket term. Unless the memory loss is functional (“supratentorial"), the cerebrum is the principal anatomic site of diseases that
... READ EXCERPTS »
... Agitation refers to a state of hyperarousal, increased tension, and irritability that can lead to confusion, hyperactivity, and overt hostility. Agitation can result from a toxic (poisons), metabolic, or infectious cause; brain injury; or a psychiatric disorder. It can also... History and physical examination ... Medical causes ... Other causes ... Special considerations
... READ EXCERPTS »
... An umbrella term for puzzling or inappropriate behavior or responses, confusion is the inability to think quickly and coherently. Depending on the cause, it may arise suddenly or gradually and may be temporary or irreversible. Aggravated by stress and sensory... History and physical examination ... Medical causes ... Other causes ... Special considerations
... READ EXCERPTS »
... A decrease in the level of consciousness (LOC), from lethargy to stupor to coma, usually results from a neurologic disorder and may signal a life-threatening complication, such as hemorrhage, trauma, or cerebral edema. However, this sign can also result from a... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
... READ EXCERPTS »
... A complex partial seizure occurs when a focal seizure begins in the temporal lobe and causes a partial alteration of consciousness — usually confusion. Psychomotor seizures can occur at any age, but their incidence usually increases during adolescence and adulthood. Two... History ... Medical causes ... Special considerations ... Pediatric pointers
... READ EXCERPTS »
... A common neurologic sign, syncope (or fainting) refers to a transient loss of consciousness associated with impaired cerebral blood supply or cerebral hypoxia. It usually occurs abruptly and lasts for seconds to minutes. An episode of syncope usually starts as a feeling of light... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers
... READ EXCERPTS »
... Neurologic or Mechanical Causes, or Both
Mediated by vagal stimulation or autonomic insufficiency, or both
Vasovagal reaction (often associated with strong emotion or pain)
... READ EXCERPTS »
... Usually No Lateralizing Signs, Normal Brainstem Reflexes
Drug withdrawal after chronic intoxication, especially
Alcohol
Barbiturates
... READ EXCERPTS »
... Degenerative diseases
Alzheimer's disease
Cerebral arteriosclerosis, multiple cerebrovascular accidents
... READ EXCERPTS »
... Congenital
Antithrombin III deficiency
Protein C deficiency
Protein S deficiency
Homocystinuria
Dysfibrinogenemias
... READ EXCERPTS »
... Primary malignant brain tumors account for about 10% to 30% of adult cancers. These tumors may occur at any age. The most common tumor types in adults are gliomas and meningiomas, which usually occur supratentorially (above the covering of the... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
... READ EXCERPTS »
... Signs and Symptoms Increased intracranial pressure, constant headache, nausea, vomiting, seizures, ocular disturbances (may be specific to area affected)
Treatment (Tx) Antibiotics,
... READ EXCERPTS »
... Agitation refers to a state of hyperarousal, increased tension, and irritability that can lead to confusion, hyperactivity, and overt hostility. Agitation can result from a toxic (poisons), metabolic, or infectious cause; brain injury; and... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers
... READ EXCERPTS »
... An umbrella term for puzzling or inappropriate behavior or responses, confusion is the inability to think quickly and coherently. Depending on its cause, confusion may arise suddenly or gradually and may be temporary or irreversible. Aggravated by stress and... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers
... READ EXCERPTS »
... A decrease in level of consciousness (LOC), from lethargy to stupor to coma, usually results from a neurologic disorder and may signal a life-threatening complication, such as hemorrhage, trauma, or cerebral edema. However, this sign can also... Emergency Interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
... READ EXCERPTS »
... A complex partial seizure occurs when a focal seizure begins in the temporal lobe and causes a partial alteration of consciousness—usually confusion. Psychomotor seizures can occur at any age, but incidence usually increases during adolescence and adulthood.... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers
... READ EXCERPTS »
... A common neurologic sign, syncope (or fainting) refers to transient loss of consciousness associated with impaired cerebral blood supply or cerebral hypoxia. It usually occurs abruptly and lasts for seconds to minutes. An episode of syncope usually... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling
... READ EXCERPTS »
... Mark W. Nickels
Acute confusional states represent an etiologically diverse spectrum of disorders that may involve alterations in thinking, perception, memory, orientation, or attention. In addition, present may be... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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... Anne Cather Cutlip
Dementia is characterized by a progressive cognitive decline leading to social or occupational disability occurring in a state of clear consciousness. It has an age-dependent epidemiology, occurring in 8% of patients aged 65 years and older in... Approach. ... History. ... Physical examination. ... Testing ... Diagnostic assessment.
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... James C. Chesnutt
Syncope is a common and concerning medical problem, which accounts for 3% of emergency room visits and up to 6% of hospital admissions. Although the cause of syncope can be life-threatening (e.g., ventricular tachycardia) and the result can be... Approach. ... History ... Physical examination ... Testing. ... Diagnostic assessment. ... Pictures
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... Linda P. Shields
Delirium, as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition criterion (1), is a condition involving an acute confusional state recognized by the patient’s change... Approach. ... History ... Physical examination. ... Testing ... Diagnostic assessment.
... READ EXCERPTS »
... Differential Overview
❑ Alzheimer disease
❑ Multi-infarct dementia
❑ Depression
❑ Drugs
... Diagnostic Approach ... Clinical Findings ... Pictures
... READ EXCERPTS »
... Differential Overview
Orthostatic/Autonomic
❑ Neurally mediated hypotension
❑ Volume depletion
❑ Cough syncope ... Diagnostic Approach ... Clinical Findings
... READ EXCERPTS »
... Differential Overview
Systemic
❑ Drugs/toxins
❑ Sepsis
❑ Hypoglycemia
❑ Hypercalcemia ... Diagnostic Approach ... Clinical Findings ... Pictures
... READ EXCERPTS »
... With an incidence of 4.5 per 100,000 patients, malignant brain tumors (gliomas, meningiomas, and schwannomas) are common (slightly more so in men than in women).
Tumors may occur at any age. In adults, incidence is generally highest... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Brain abscess is a free or encapsulated collection of pus that usually occurs in the temporal lobe, cerebellum, or frontal lobes. It can vary in size and may present singly or multilocularly. Brain abscess has a relatively low occurrence. Although it can... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... A decrease in level of consciousness (LOC), from lethargy to stupor to coma, usually results from a neurologic disorder and may signal a life-threatening complication, such as hemorrhage, trauma, or cerebral edema. However, this sign can also result from a metabolic, GI,... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... A common neurologic sign, syncope (or fainting) refers to transient loss of consciousness associated with impaired cerebral blood supply or cerebral hypoxia. It usually occurs abruptly and lasts for seconds to minutes. An episode of syncope usually starts as a feeling of... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... Agitation refers to a state of hyperarousal, increased tension, and irritability that can lead to confusion, hyperactivity, and overt hostility. Agitation can result from a toxic (poisons), metabolic, or infectious cause; brain injury; or a... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... An umbrella term for puzzling or inappropriate behavior or responses, confusion is the inability to think quickly and coherently. Depending on its cause, confusion may arise suddenly or gradually and may be temporary or irreversible. Aggravated by stress and sensory... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... A decrease in level of consciousness (LOC), which can range from lethargy to stupor to coma, usually results from a neurologic disorder and may signal a life-threatening complication, such as hemorrhage, trauma, or cerebral edema. However, this sign can also result from metabolic, GI,... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... A complex partial seizure occurs when a focal seizure begins in the temporal lobe and causes a partial alteration of consciousness — usually confusion. Psychomotor seizures can occur at any age, but incidence usually increases during adolescence and adulthood. Two-thirds of... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... A common neurologic sign, syncope (or fainting) refers to transient loss of consciousness associated with impaired cerebral blood supply or cerebral hypoxia. It usually occurs abruptly and lasts for seconds to minutes. An episode of syncope usually starts... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
...Syncope is a transient loss of consciousnessand postural tone usually produced by impaired cerebral blood flow.Generally, a syncopal episode in childhood is a benign isolatedevent; however, some causes can be life threatening. Because dizzinessoften precedes syncope, it is also... Principal Causes of Syncope and Dizziness ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
... READ EXCERPTS »
... Agitation refers to a state of hyperarousal, increased tension, and irritability that can lead to confusion, hyperactivity, and overt hostility. It can result from a toxic (poisons), metabolic, or infectious cause; brain injury; or a psychiatric disorder. Agitation can also... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... An umbrella term for puzzling or inappropriate behavior or responses, confusion is the inability to think quickly and coherently. Depending on the cause, it may arise suddenly or gradually and may be temporary or irreversible. Aggravated by stress and sensory... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... A decrease in the level of consciousness (LOC), from lethargy to stupor to coma, usually results from a neurologic disorder and may signal a life-threatening complication, such as hemorrhage, trauma, or cerebral edema. However, this sign can also result from a metabolic,... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... A complex partial seizure occurs when a focal seizure begins in the temporal lobe and causes a partial alteration of consciousness—usually confusion. Psychomotor seizures can occur at any age, but their incidence usually increases during... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... A common neurologic sign, syncope (or fainting) refers to a transient loss of consciousness associated with impaired cerebral blood supply or cerebral hypoxia. It usually occurs abruptly and lasts for seconds to minutes. An episode of syncope usually starts as... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
...
A hallucination is seeing, hearing, touching, smelling, or tasting
something that is not there. Auditory hallucinations without evidence of
mental deterioration usually indicate schizophrenia, but epilepsy, drug
toxicity, and
... READ EXCERPTS »
...
The differential of syncope or a brief loss of consciousness is best
developed with the use of physiology and, to a lesser extent,
anatomy. Like convulsions , syncope is due to a diminished supply of oxygen and glucose
in the brain cell. Anything that... Pictures
... READ EXCERPTS »
...
Memory loss is a real symptom and sign, but organic brain syndrome
should be dropped from usage because it is a wastebasket term. Unless the
memory loss is functional (“supratentorial”), the cerebrum is the
principal anatomic site of diseases that... Pictures
... READ EXCERPTS »
...
The differential diagnosis of delirium is very similar to that for
coma, and one finds the mnemonic VINDICATE useful in this regard.
V—Vascular disorders of the brain including hemorrhage, embolism,
... READ EXCERPTS »
... Author:
Esther Forrester, MD
What to Do - Make a Decision
To have a thorough understanding of fluid and electrolyte issues, one must
truly understand the body's composition of solutes and water and how equilibrium is maintained in normal circumstances. Water is... Suggested Readings ... Pictures
... READ EXCERPTS »
Among the new treatments for Parkinson's disease, one of the most talked-about is a high-tech device that triggers "deep brain stimulation."...
A brain tumor diagnosis in a child can be scary and confusing for the child and immeasurably painful for his parents. On today's webcast...
On this webcast, 11-year-old Ahmad Abdella joins us to talk about life after brain surgery. What are his feelings about the procedure? How was his...
Cancers of all kinds are frightening illnesses, and the idea of a brain tumor seems especially threatening. So when parents face the news that their...