DELIRIUM
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 arteriosclerosis may cause delirium.
I—Inflammatory disorders of the nervous system that may cause
delirium include viral encephalitis, meningitis, syphilis, malaria and other
parasites, rabies, and cerebral abscess. Generalized infections, usually
when associated with fever, may be responsible.
N—Neoplasms of the brain are not usually associated with delirium
until the end stages at which time the cause will be obvious.
D—Deficiency disorders that may be associated with delirium include
Wernicke encephalopathy, pellagra, and pernicious anemia. Delirium may be
associated with degenerative disorders such as Alzheimer disease.
I—Intoxication by an enormous number of exogenous and endogenous
substances may cause delirium. Alcohol, cocaine, heroin, phencyclidine
(PCP), marijuana, lead, arsenic, and manganese are just a few of the
exogenous substances. Endogenous substances include uremia, ammonia from
hepatic failure, hyperinsulinemia, diabetic ketosis, and porphyria. Delirium
may be associated with the withdrawal of a patient from alcohol and/or any
drug including morphine, cocaine, or tobacco.
C—Convulsive disorders may be associated with delirium either during
or after the seizure.
A—Autoimmune disorders such as lupus erythematosus are associated
with inflammation of vasculitis in the brain causing delirium.
T—Trauma may cause a concussion, cerebral hemorrhage, or subdural or
epidural hematoma leading to delirium.
E—Endocrine disorders associated with delirium include insulinoma
and diabetes.
Approach to the Diagnosis
It is essential to get a history of drug or alcohol use from the
patient or family, and a drug screen may be done in most cases. Infection is
another common cause. The workup should also include a CBC, sedimentation
rate, urinalysis, antinuclear antibody (ANA) analysis, chemistry panel, and
electrolytes. A CT scan or MRI of the brain will be necessary in most cases.
It may be wise to administer intravenous thiamine and glucose while awaiting
the results of blood work. If there is a fever, blood cultures and possibly
a spinal tap (after a CT scan or MRI has ruled out a space-occupying lesion)
may be indicated. Arterial blood gas analysis and carboxyhemoglobin should
be determined. A neurologist or neurosurgeon needs to be consulted early in
the workup.
Other Useful Tests
-
EEG (seizure disorder)
- Venereal disease research laboratory (VDRL) test (neurosyphilis)
- Carotid sonogram (carotid thrombosis)
- Four-vessel angiography (transient ischemic attack [TIA])
- Glucose tolerance test (diabetes, insulinoma)
- Blood smear for malarial parasites (malaria)
- Psychiatric consult
- Urine porphobilinogen (porphyria)
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.
Other Book Chapters Related to Cognitive impairment
Read excerpts from these other book chapters related to Cognitive impairment:
Medical Books Excerpts
- DELIRIUM
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- DEMENTIA
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Delirium
- "In A Page: Pediatric Signs and Symptoms" (2007)
- [ read ]
- DELIRIUM
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- Dementia*
- "A Pocket Manual of Differential Diagnosis" (1999)
- [ read ]
- Delirium
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Dementia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Memory Impairment
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- DELIRIUM
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
More About Causes of Cognitive impairment
» Next page:
MEMORY LOSS AND DEMENTIA (Differential Diagnosis in Primary Care)
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