Disorders of consciousness Flashcards
What is delirium
Acute/sudden confusional state developing within hrs/days (unlike alzheimers) - disturbance of consciousness causing reduced ability to focus or shift attention - fluctuates
Key features of delirium
Evidence of disturbance caused by medical condition, substance intoxication or medication side effect
Sx not explained by pre-existing dementia
Delirium risk factors
Older age
Systemtic Illness (heart attack, stroke, alcohol/drugs, heart failure, renal failure, liver failure, ICU stay, recent surgery/anaesthesia)
INFECTION (UTI, PNEUMONIA, sepsis)
Dehydration
Polypharmacy
Pre-existing dementia
Electrolyte imbalance
metabolic problems (thyroid disorders)
Sleep deprivation
Visual/hearing problems
Symptoms of delirium
Hypoactive or hyperactive
Reduced awareness of environment
Confusion
Drowsy
Distractable
NEW memory impairment (unlike alzheimers)
Hallucinations
Delusions and change in personality/mood
FLUCTUATIONS (unlike dementia)
DDx of delirium
Dementia - progressive
Psychosis
Depression
Stroke
Delirium Ix
The Confusion Assessment Method (CAM) can be used as a scoring system for identifying delirium
Initial
- History, physical exam (low temp could mean cold sepsis) , neurologic exam
- FBC, electrolytes, renal and liver panel
- URINALYSIS and MC&S
- Blood culture
- Toxicology
- Cardiac enzymes / Pro-BNP
- ABG
Scans
- chest X ray (pneumonia, pneumothorax (lack of O2), mass/tumour, heart failure)
- ECG - arryhthmias
- CT/MRI (haemorrhage, encephalitis etc…)
- lumbar puncture (meningitis, subarachnoid haemorrhage)
- EEG
- USS of abdomen and bladder
Delirium management
Treatment of underlying cause
- antibiotcs
- rehydration
- stop meds that may cause
- correct electrolyte, glucose imbalance
sedation if needed - haloperidol or lorazepam
What is meningitis
Meningitis is inflammation of the meninges (PAD - pia mater, arachnoid mater, dura mater)
Usually due to infection (or malignancy/medications) - potentially life threatening condition
Cause of bacterial meningitis
Strep pneumonia esp due to drug resistance to penicillin
N. meningitidis
Common if immunosuppressed e.g. cancer, HIV or if had recent neurosurgery - fatal (high mortality but rare)
Bacterial meningitis symptoms
Fever - rapidly developing
Stiff neck
Headache
Seizures
Photophobia
Altered mental state
Nausea and vomiting
Rash (meningococcemia) or signs of sepsis (non blanching petechial rash)
Bacteria meningitis Ix and findings
Kernig’s sign
Brudzinski’s sign
Blood test and cultures - gives antibiotics immediately after this
Lumbar puncture of CSF - LOW GLUCOSE AND HIGH PROTEIN!!! High WBC = turbid
CT head - mass/tumour
Bacterial meningitis treatment
IV antibiotics twice daily - ceftriaxone or vancomycin
Add ampicillin/amoxicillin in older than 65 due to possible listeria monocytogenes
- give chloramphenicol if allergic to penicillin
IV Steroids (dexamethasone) - to prevent hearing loss (give at same time as antibiotics and continue for 4 days)
Sepsis management
Fluids
BP management with vasoconstrictors
Viral meningitis presentation and findings
Not life threatening and quite common
Cold like symptoms
Typical meningitis symptoms (fever, neck stiffness, vomiting, headache, photophobia, altered consciousness, seizures)
Lumbar puncture - clear, mildy raised/normal protein, normal glucose, high WBC
No bacteria on blood cultures
Viral meningitis management
IV aciclovir
