HALLUCINATIONS
HALLUCINATIONS: Excerpt from Differential Diagnosis in Primary Care
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 often
the sign of drug or alcohol intoxication, but occasionally they occur in
schizophrenia. Hallucinations with mental deterioration should prompt the
recall of the differential diagnosis for memory loss . When faced with a hallucinating patient, think of
the mnemonic MINT, and a list of possibilities can be recalled easily.
M—Mental disease brings to mind schizophrenia, manic depressive
psychosis, and paranoid states.
I—Intoxication and inflammation suggest alcoholism, cannabis,
lysergic acid diethylamide (LSD), bromism, various other drugs, and
encephalitis, cerebral abscess (temporal lobe especially), and syphilis. The
I should also suggest idiopathic disorders such as epilepsy,
presenile dementia, and arteriosclerosis.
N—Neoplasm suggests brain tumors. A tumor of the occipital lobe may
present with visual hallucinations, whereas a tumor of the temporal lobe
causes auditory hallucinations or uncinate fits (i.e., bad smells). A tumor
of the parietal lobe may present with tingling or other paresthesias of the
body.
T—Trauma should suggest concussions, epidural or subdural hematomas,
and depressed skull fractures.
HAND AND FINGER PAIN
|
| I | C | A | T | E |
| Intoxication | Congenital | Autoimmune | Trauma | Endocrine |
|
| | Allergic | | |
|
|
| Contact dermatitis Erythema multiforme |
Contusion |
| |
| |
De Quervain stenosing tenosynovitis |
Ganglion |
Scleroderma |
Hematoma Contusion Ruptured
tendon |
| |
|
|
Buerger disease |
Vasculitis Rheumatoid arthritis |
Laceration Contusion |
Menopause |
|
| Buerger disease |
|
|
| Amyloidosis Rheumatoid arthritis |
|
Laceration Contusion |
Myxedema Acromegaly Diabetes
mellitus |
Scalenus anticus syndrome |
Cervical rib |
|
Costoclavicular compression |
| |
|
|
| Rheumatoid spondylitis |
Herniated disc Fracture | |
|
Gout |
|
Rheumatoid arthritis Lupus erythematosus |
Fracture Sprain Contusion | |
|
Approach to the Diagnosis
In the workup of hallucinations, it is essential to get a drug history
from a relative or friend if not from the patient. Ask about a family
history of epilepsy or head trauma. A drug screen should be ordered. If
there is no mental deterioration, referral to a psychiatrist may be done but
an electroencephalogram (EEG) may
still be indicated. With mental deterioration, a neurologist should be
consulted. When there is doubt about mental deterioration, psychologic
testing may be done. Computed tomography (CT) scans, EEGs, skull x-ray
films, and arteriograms may be necessary in selected cases.
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
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