Delir erkennen in 3 Schritten

2019 ◽  
Vol 144 (23) ◽  
pp. 1619-1628
Author(s):  
Rebecca von Haken ◽  
Hans-Christian Hansen
Keyword(s):  
Hospital Setting ◽  
Altered Mental Status ◽  
Altered Level ◽  
Curative Therapy ◽  
Medical Interventions ◽  
Operative Care ◽  
Level Of Consciousness ◽  
Triggering Mechanisms ◽  
The Brain

Abstract Background Clinicians are commonly confronted with the differential diagnosis of altered mental status, impaired cognition and altered level of consciousness in hospitalized patients including those admitted to medical, geriatric, emergency, intensive and post-operative care units. Although delirium is the most common acute neuropsychiatric condition in the acute hospital setting this diagnosis is commonly delayed, made too late or missed altogether. Difficulties and importance of timely diagnosis The causes of delirious states are manifold. Both, direct damage to the brain tissue as well as encephalopathy as a result of other medical diseases, can be the cause of delirium. Depending on the predisposition delirious syndromes can be provoked by minor medical interventions. Clinical presentation is very variable, but remains largely independent of the triggering mechanisms. Purely catatonic, hypoactive, hyperactive and excitatory types as well as mixed forms can be distinguished.Immediate diagnosis of a delirious syndrome and rapid elucidation of its causes are keys for the implementation of curative therapy. There is a need to act fast because delirious phases are associated with significantly longer hospital stay and increased morbidity as a result of long-term cognitive deficits as well as increased mortality. As negative outcome is closely linked to the duration of a delirious episode, early diagnosis and rapid termination of the delirium constitute a significant positive predictor of outcome. In this respect, delirium represents an emergency, with or without concomitant cerebral or extracerebral symptoms.

scholarly journals Altered Mental Status and Cyanosis in a Pediatric Patient with Methemoglobinemia

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Phillip M. Grenz ◽  
Robert N. Ray Jr. ◽  
Olivia A. Hardy ◽  
Andrew L. Koons ◽  
Kenneth D. Katz ◽  
...  
Keyword(s):  
Mental Status ◽  
Clinical Manifestations ◽  
Altered Mental Status ◽  
Pediatric Emergency ◽  
Abrupt Onset ◽  
Altered Level ◽  
Sustained Improvement ◽  
Oxygen Dissociation ◽  
Nail Polish ◽  
Level Of Consciousness

Methemoglobinemia results from increased amounts of oxidized hemoglobin in the blood with an ensuing change in oxygen dissociation curve and lack of oxygen delivery to tissue. A previously well, male toddler was brought to the Pediatric Emergency Department (PED) by Emergency Medical Services (EMS) with abrupt onset of altered mental status and cyanosis after a suspected ingestion of “Rush” nail polish remover. He was quickly diagnosed with methemoglobinemia by both clinical presentation and chocolate-colored blood appearance. He emergently received intravenous (IV) methylene blue (MB) with immediate and sustained improvement requiring no further doses. Though inhalation of nitrites and subsequent methemoglobinemia is frequently reported in adolescents, we were unable to find any cases in the literature detailing ingestion of this product and the resulting clinical manifestations. Our objective with this report is to describe a rare case of a toddler with an accidental ingestion of “Rush” nail polish remover, a nitrite compound. Our patient presented to the PED with abrupt onset of altered level of consciousness, hypotension, and cyanosis resulting from acquired methemoglobinemia. This case report demonstrates the importance of emergency clinicians being able to make clinical judgements and decisions based on the history and physical exam when methemoglobinemia is suspected.

scholarly journals Cardioprotective Therapy in the Practice of an Anaesthesiologist

2020 ◽  
Author(s):  
Arina Viacheslavovna Balan
Keyword(s):  
Neurological Status ◽  
Underlying Disease ◽  
Research Papers ◽  
Vital Functions ◽  
Level Of Consciousness ◽  
Life Threatening ◽  
Published Research ◽  
The Brain ◽  
Careful Assessment

All components of anaesthesia have a direct or indirect depressing effect on the myocardium and functional activity of the brain. Given the initial failure of the coronary blood flow, life-threatening disorders of the heart are possible. The higher the severity of the underlying disease, the greater the risk of transient neurological deficit, stroke. Extended continuous monitoring of vital functions, careful assessment of the neurological status of the patient with special attention to the level of consciousness, the presence or absence of symptoms of increased ICP is necessary. The purpose of this study is to evaluate the beneficial effect of cardioprotectors Mexicor, Meldonium in the fight against ischemia in patients with CHD, GB in the department of surgical profile. The following methods have been used: review of literature, previously published research papers. Results: this article discusses the main drugs with cardioprotective properties, describes the positive experience of using them by specialists, and proves the effectiveness of using drugs in the long term.

scholarly journals When the grass isn’t greener: a case series of young children with accidental marijuana ingestion

CJEM ◽  
2015 ◽  
Vol 18 (6) ◽  
pp. 480-483 ◽  
Author(s):  
Derek Murray ◽  
Joshua Olson ◽  
Ana Sofia Lopez
Keyword(s):  
Young Children ◽  
Illicit Drug ◽  
Case Series ◽  
Altered Mental Status ◽  
Altered Level ◽  
The Past ◽  
High Prevalence ◽  
Level Of Consciousness ◽  
Local Emergency Department ◽  
Marijuana Intoxication

AbstractMarijuana is the most commonly used illicit drug in Canada, with 10% of the general population admitting to its use in the past year. This high prevalence increases risk of accidental ingestion in young children.We report four pediatric cases of accidental marijuana ingestion who presented to our local emergency department with altered mental status. Three patients had extensive testing, including one patient who underwent lumbar puncture and empirical treatment for meningitis. To our knowledge, this is the first Canadian case series since McNabb et al., published over 2 decades ago.The case series aims to highlight the importance of considering acute marijuana intoxication in the differential diagnosis when assessing young children with altered level of consciousness.

scholarly journals Modern aspects of neuropathogenesis and neurological manifestations of COVID-19

2021 ◽  
Vol 17 (2) ◽  
pp. 6-15
Author(s):  
L.A. Dziak ◽  
O.S. Tsurkalenko ◽  
K.V. Chekha ◽  
V.M. Suk
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Psychiatric Symptoms ◽  
Clinical Manifestations ◽  
The Body ◽  
Altered Level ◽  
Wide Range ◽  
The Central Nervous System ◽  
The Brain

Coronavirus infection is a systemic pathology resulting in impairment of the nervous system. The involvement of the central nervous system in COVID-19 is diverse by clinical manifestations and main mechanisms. The mechanisms of interrelations between SARS-CoV-2 and the nervous system include a direct virus-induced lesion of the central nervous system, inflammatory-mediated impairment, thrombus burden, and impairment caused by hypoxia and homeostasis. Due to the multi-factor mechanisms (viral, immune, hypoxic, hypercoagulation), the SARS-CoV-2 infection can cause a wide range of neurological disorders involving both the central and peripheral nervous system and end organs. Dizziness, headache, altered level of consciousness, acute cerebrovascular diseases, hypogeusia, hyposmia, peripheral neuropathies, sleep disorders, delirium, neuralgia, myalgia are the most common signs. The structural and functional changes in various organs and systems and many neurological symptoms are determined to persist after COVID-19. Regardless of the numerous clinical reports about the neurological and psychiatric symptoms of COVID-19 as before it is difficult to determine if they are associated with the direct or indirect impact of viral infection or they are secondary to hypoxia, sepsis, cytokine reaction, and multiple organ failure. Penetrated the brain, COVID-19 can impact the other organs and systems and the body in general. Given the mechanisms of impairment, the survivors after COVID-19 with the infection penetrated the brain are more susceptible to more serious diseases such as Parkinson’s disease, cognitive decline, multiple sclerosis, and other autoimmune diseases. Given the multi-factor pathogenesis of COVID-19 resulting in long-term persistence of the clinical symptoms due to impaired neuroplasticity and neurogenesis followed by cholinergic deficiency, the usage of Neuroxon® 1000 mg a day with twice-day dosing for 30 days. Also, a long-term follow-up and control over the COVID-19 patients are recommended for the prophylaxis, timely determination, and correction of long-term complications.

scholarly journals Multipattern botulinum toxin therapy of post-comatose long-term consciousness disorders: central effects

2019 ◽  
Vol 21 (2) ◽  
pp. 78-87
Author(s):  
Yu I Vainshenker ◽  
V A Zinserling ◽  
L A Melucheva ◽  
V V Bobrova ◽  
A D Korotkov ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Functional State ◽  
Proliferating Cells ◽  
Gradual Improvement ◽  
Consciousness Disorders ◽  
Positron Emission ◽  
Botulinum Toxin Therapy ◽  
Level Of Consciousness ◽  
The Brain

The data of electroencephalography, evoked potentials of the brain and positron emission tomography are analyzed before and 3 weeks after the multipattern botulinum toxin therapy of spasticity in 25 patients with post-comatose long-term consciousness disorders, including one patient who died against the backdrop gradual improvement of consciousness from acute heart failure four months after the end of second course of multipattern botulinum toxin therapy. Found that improvements of the brain functional state against the backdrop of reduced spasticity were observed regardless of primary brain damage origin, level of consciousness and of multipattern botulinum toxin therapy course repeatability. The observed dynamics of neurophysiological indicators had a normalizing direction, some differences associated with the initial level of consciousness. Electrophysiological changes during the improvement of consciousness against the background of multipattern botulinum toxin therapy were not specific. Features of improving energy metabolism in the certain areas of the brain could be caused by just such treatment, and reflected the contribution of pathological sensorimotor integration in maintaining impaired consciousness. Postmortem neuromorphological study of the patient brain identified progenitor stem and proliferating cells and newly formed neurons in brain areas whose in-life functional state was continuously improving, newly formed neurons migrating flow through the corpus callosum and diffuse activation of axonogenesis. We assume that the central effect of multipattern botulinum toxin therapy associated with improvement of consciousness, may be a double. The first is immediate, due to a decrease in pathological afferentation from the muscles, the second - apparently deferred and prolonged, manifested in the activation of functional neurogenesis and axonogenesis in the brain. The continuation of complex multimodal research on the study of post-comatose long-term consciousness disorders seems promising.

COGNITIVE IMPAIRMENT IN PATIENTS WITH CORONAVIRUS INFECTION

2021 ◽  
Vol 2 (1) ◽  
pp. 5-8
Author(s):  
Gulnoza Urinova ◽  
◽  
Nargiza Nasirtdinova ◽  
Janna Nazarova
Keyword(s):  
Cognitive Impairment ◽  
Neurological Disorders ◽  
Sinus Thrombosis ◽  
The Novel ◽  
Altered Level ◽  
Wide Range ◽  
Level Of Consciousness ◽  
Coronavirus Infection ◽  
Novel Coronavirus ◽  
The Brain

Thisarticle discusses cognitive impairment in patients with coronavirus infection and explains that observations have been made on this topic. The novel coronavirus infection COVID-19 caused by the SARS-CoV-2 coronavirus poses a global health threat. Neurological disordersfound in patients with coronavirus infection have a wide range of clinical neurological signs: headache, dizziness, altered level of consciousness, acute cerebrovascular accident (ACVE), venous sinus thrombosis the brain [12].Keywords:coronavirus infection, cognitive impairment, neurological disorders, headache, dizziness, muscle weakness, encephalopathy, encephalitis

The unconscious patient

2020 ◽  
pp. 5901-5908
Author(s):  
David Bates
Keyword(s):  
Specific Treatment ◽  
Systemic Infection ◽  
Bowel Function ◽  
Irreversible Damage ◽  
Metabolic Derangement ◽  
Skin Circulation ◽  
Level Of Consciousness ◽  
Traumatic Coma ◽  
The Brain

Prolonged loss of consciousness (coma, defined as a Glasgow Coma Score of 8 or less) is seen commonly: (1) following head injury, (2) after an overdose of sedating drugs, and (3) in the situation of ‘non-traumatic coma’, where there are many possible diagnoses, but the most common are postanoxic, postischaemic, systemic infection, and metabolic derangement (e.g. hypoglycaemia). Urgent assessment is required to identify and, where possible, correct the pathological cause, and protect the brain from the development of irreversible damage. Specific treatment (if any) will depend upon the particular cause of coma, but—whatever the cause—long-term attention is required to the patient’s respiration, skin, circulation, and bladder and bowel function, seizures must be controlled, and the level of consciousness should be regularly assessed and monitored.

Delirium

2017 ◽  
pp. 363-372
Author(s):  
Alasdair M. J. MacLullich ◽  
Edward R. Marcantonio ◽  
David J. Meagher
Keyword(s):  
Trauma Surgery ◽  
Adverse Outcomes ◽  
Medical Emergency ◽  
Medical Illness ◽  
Detection Rates ◽  
Altered Level ◽  
Vulnerable Patients ◽  
Mortality Causes ◽  
The Brain

Delirium is a complex medical emergency affecting at least 15% of older hospitalized patients. It causes considerable patient and carer distress, and is associated with adverse outcomes including falls, increased length of stay, new institutionalization, new and exacerbated long-term cognitive impairment, and mortality. Causes include medical illness, trauma, surgery, psychological stress, and drugs. The mechanisms involve direct effects on the brain such as hypoxia, and likely altered inflammatory and stress pathways. Older age, neurodegeneration, and medical comorbities greatly increase vulnerability. Detection involves eliciting evidence of acute inattention, altered level of arousal, and/or psychosis; brief tools such as the 4AT can improve detection rates. Care involves multiple aspects: treating all precipitating causes, optimizing general care, communicating with patients and carers, preventing complications, and treating distress and agitation. Detection of undiagnosed underlying dementia is important. Risk reduction in vulnerable patients, involving optimizing medical status, the care environment, and patient experience, is effective.

Latent class analysis of the multivariate Delirium Index in long-term care settings

2018 ◽  
Vol 31 (1) ◽  
pp. 59-72
Author(s):  
Antonio Ciampi ◽  
Chun Bai ◽  
Alina Dyachenko ◽  
Jane McCusker ◽  
Martin G. Cole ◽  
...  
Keyword(s):  
Time Evolution ◽  
Memory Impairment ◽  
Latent Class ◽  
Long Term Care ◽  
Quebec City ◽  
Latent Classes ◽  
Term Care ◽  
Altered Level ◽  
Level Of Consciousness

ABSTRACTBackground:A few studies examine the time evolution of delirium in long-term care (LTC) settings. In this work, we analyze the multivariate Delirium Index (DI) time evolution in LTC settings.Methods:The multivariate DI was measured weekly for six months in seven LTC facilities, located in Montreal and Quebec City. Data were analyzed using a hidden Markov chain/latent class model (HMC/LC).Results:The analysis sample included 276 LTC residents. Four ordered latent classes were identified: fairly healthy (low “disorientation” and “memory impairment,” negligible other DI symptoms), moderately ill (low “inattention” and “disorientation,” medium “memory impairment”), clearly sick (low “disorganized thinking” and “altered level of consciousness,” medium “inattention,” “disorientation,” “memory impairment” and “hypoactivity”), and very sick (low “hypoactivity,” medium “altered level of consciousness,” high “inattention,” “disorganized thinking,” “disorientation” and “memory impairment”). Four course types were also identified: stable, improvement, worsening, and non-monotone. Class order was associated with increasing cognitive impairment, frequency of both prevalent/incident delirium and dementia, mortality rate, and decreasing performance in ADL.Conclusion:Four ordered latent classes and four course types were found in LTC residents. These results are similar to those reported previously in acute care (AC); however, the proportion of very sick residents at enrolment was larger in LTC residents than in AC patients. In clinical settings, these findings could help identify participants with a chronic clinical disorder. Our HMC/LC approach may help understand coexistent disorders, e.g. delirium and dementia.

scholarly journals Serotonin Syndrome Presenting as a Posterior Reversible Encephalopathy Syndrome

2020 ◽  
Vol 12 (1) ◽  
pp. 63-68 ◽  
Author(s):  
Muhammad Taimur Malik ◽  
Mohammad Faraz Majeed ◽  
Ramin Zand
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Serotonin Syndrome ◽  
Altered Mental Status ◽  
Imaging Findings ◽  
Unique Case ◽  
Altered Level ◽  
Posterior Reversible Encephalopathy ◽  
Level Of Consciousness ◽  
Neurological Exam ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome characterized by an altered level of consciousness, headaches, seizure, and visual changes. PRES has several different etiologies, including malignant hypertension, eclampsia, and certain medications. Here, we describe a 41-year-old woman who presented with altered mental status. She had a preliminary diagnosis of serotonin syndrome as she was on many different serotonin-sparing agents, but her imaging findings were consistent with PRES. After her medications were reviewed and the causative agent was removed, the patient’s neurological exam and imaging findings improved, and she returned to her baseline. To our knowledge, this is a unique case of PRES caused by serotonin syndrome secondary to venlafaxine usage.

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