Delirium

Introduction Because of the overheating of the heat or the disturbance of the bonfire, the confusion, gibberish, illusion of illusion, emotional disorder, or excitement and other symptoms. It is a common brain organic syndrome in general hospitals, and it is not uncommon in psychiatric clinics. Due to its heavier performance and a certain life threat, it should be given priority. Usually the onset is acute and the condition fluctuates significantly. This syndrome is common in elderly patients. The patient's cognitive function declines, the degree of arousal changes, the sense of abnormality, and the day and night are reversed. It is not a disease, but a clinical syndrome caused by a variety of causes.

Cause

Metabolic or toxic causes: In fact, any metabolic disease can cause paralysis, and in the elderly, adverse drug reactions are the most common cause. In winter, attention should be paid to carbon monoxide poisoning, acute and chronic alcoholism, food poisoning (muscarinic, botulinum, etc.), industrial poisoning (mercury, benzene).

Structural causes: Structural lesions that can trigger sputum include cerebrovascular occlusion and cerebral infarction, subarachnoid hemorrhage, primary or metastatic brain tumors, subdural hematoma, and brain abscess. Most structural lesions can be detected by CT or MRI, and many lesions can produce focal neurological signs that can be observed during a physical examination.

Infectious cause: The infectious cause of spasticity may be acute meningitis or encephalitis or various infections outside the brain, which may cause paralysis through the production of toxins or fever. Pneumonia (even without an oxygen-suppressed person), urinary tract infections, sepsis, or fever caused by a viral infection can cause confusion in a vulnerable brain. It is difficult to develop a clinical diagnosis of a slower abscess or opportunistic infection. In some cases, a brain biopsy may be needed to correctly determine.

an examination

Related inspection

CT examination EEG examination electrocardiogram

1. Laboratory tests include whole blood routine, blood glucose, liver function, renal function, blood ammonia, blood gas analysis, urine analysis, and urine drug screening.

2. Perform a series of EEGS follow-up observations to see that there is a substantial change in EEGs. Structural damage and general slowing of brain wave rhythms are the most common changes. The degree of rhythm reduction is related to the degree of paralysis.

3. Intracranial causes cause other EEG changes, including focal slow waves, asymmetric activity and paroxysmal release (spine, spike, spine-slow wave synthesis). Periodically integrated waves such as three-phase waves and periodic ectopic epilepsy are used to facilitate the diagnosis of sputum caused by focal brain damage such as liver failure and cerebral hemorrhage.

4. Other auxiliary examinations include chest radiograph, electrocardiogram, CT, MRI, etc.

Differential diagnosis

It should be differentiated from other symptoms that can cause disturbance of consciousness.

Complex partial seizures of epilepsy: complex partial seizure (CPS), also known as temporal lobe episodes, psychomotor seizures, with partial seizures with varying degrees of disturbance of consciousness. Epileptic discharge originates from the temporal or frontal lobe. The origin, diffusion pathway and velocity are different. The clinical manifestations may vary greatly. A partial partial seizure may occur first (the time may be long or short), and then the disturbance of consciousness may occur. Special sensations or simple autonomic symptoms are often aura, and the onset of deep structures (medial temporal margin, limbic system, etc.) such as psychotic seizures (aura) may be short, and soon consciousness disturbances may occur, or conscious disturbances may begin. Even simply manifesting a disturbance of consciousness.

Absence of epilepsy: The absence of epileptic seizures is dominated by disturbances of consciousness, characterized by a sudden onset of seizures without any aura. The patient's ongoing movement is suddenly interrupted, dazed, and can be accompanied by a double eye flip. If the patient is speaking, his speech will slow down or terminate. If he is walking, he may suddenly stand still and stay awake. He may suddenly break free from the hand of the adult and walk a few steps forward. He suddenly cries and looks for his parents. If the chopsticks with food are suddenly stopped in the middle of the mouth when eating, they can't answer the question. Some patients can stop the attack when they talk to them. This episode lasts from a few seconds to 30 seconds, and more than one minute is rare.

Inter-temporal disorder: interictal disorder: This type of mental disorder refers to a group of unconscious disorders, but the duration of its psychiatric symptoms is protracted and can last for months to years. Including chronic psychiatric state-like psychosis, neurological symptoms, personality changes, intelligent defects and sexual dysfunction. Interictal psychosis occurs between episodes and is not directly related to the seizure itself. It is relatively rare compared with mental disorders at the time of onset and after the onset, accounting for about 10% to 30% of non-selected cases. However, in terms of severity and duration, clinically more pronounced than onset and after onset, the latter is usually short-lived and often self-limiting. It is a clinical classification of epilepsy disorders.

Signs of brain stem damage: The brain stem contains not only most of the cranial nerve nucleus (except the olfactory nerve and optic nerve), but also the whole body sensation and the motor conduction beam pass through the brainstem. The respiratory circulatory center is also located here, while the brainstem reticular structure is involved. Maintain an important structure of awareness. Therefore, after brain stem injury, in addition to the local brain damage, the disturbance of consciousness and motor dysfunction are often more serious, and there may be failure of respiratory and circulatory function, which is life-threatening.

Judgment and orientation disorder: Orientation is the ability to detect and recognize the surrounding environment (time, location, people) and its own state (name, age, occupation, etc.). Orientation disorder is an important criterion for the determination of disturbance of consciousness. Disorientation refers to the continued lack of orientation for people, places, time or the environment for more than 3-6 months. Judgment refers to the ability of a person to recognize something about a certain thing or an individual. Many brain diseases can cause judgment and disorientation in the human body.

Orientation Disorder: Orientation is the ability to detect and recognize the surrounding environment (time, location, people) and its own state (name, age, occupation, etc.). Orientation disorder is an important criterion for the determination of disturbance of consciousness. In some special cases, the orientation force has nothing to do with the disturbance of consciousness, such as the loss of time orientation of the person who has been detained or isolated for a long time, the loss of location and spatial orientation of the lost person.

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