Delirium other diagnostic studies: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Delirium}} | {{Delirium}} | ||
{{CMG}}; {{AE}} {{PB}}; [[User:Vishal Khurana|Vishal Khurana]], M.B.B.S., M.D. [mailto:vishdoc24@gmail.com] | {{CMG}}; {{AE}} {{Sara.Zand}} {{PB}}; [[User:Vishal Khurana|Vishal Khurana]], M.B.B.S., M.D. [mailto:vishdoc24@gmail.com] | ||
==Overview== | ==Overview== | ||
[[EEG]] | [[EEG]] maybe helpful for the diagnosis of [[delirium]]. [[EEG]] findings associated with [[delirium]] include [[periodic discharges]], triphasic waves ,lateralized [[rhythmic]] delta ,low voltage/generalized attenuation, theta or delta generalized slowing.The presence of either theta or delta generalized slowing correlated strongly with [[delirium]] severity regardless of [[arousal]] state (hyper- or hypoactive) and [[comorbidities]]. | ||
==Other Diagnostic Studies== | ==Other Diagnostic Studies== | ||
# '''EEG''' | # '''EEG''' | ||
# '''Lumbar Puncture''' | # '''Lumbar Puncture''' | ||
===EEG=== | ===EEG=== | ||
* [[EEG]] shows diffuse slowing. | * [[EEG]] shows diffuse slowing which is an indicator of [[delirium]] severity.<ref name="KimchiNeelagiri2019">{{cite journal|last1=Kimchi|first1=Eyal Y.|last2=Neelagiri|first2=Anudeepthi|last3=Whitt|first3=Wade|last4=Sagi|first4=Avinash Rao|last5=Ryan|first5=Sophia L.|last6=Gadbois|first6=Greta|last7=Groothuysen|first7=Daniël|last8=Westover|first8=M. Brandon|title=Clinical EEG slowing correlates with delirium severity and predicts poor clinical outcomes|journal=Neurology|volume=93|issue=13|year=2019|pages=e1260–e1271|issn=0028-3878|doi=10.1212/WNL.0000000000008164}}</ref> | ||
* [[EEG]] is useful to differentiate [[delirium]] from following [[conditions]]: | * [[EEG]] is useful to differentiate [[delirium]] from following [[conditions]]: | ||
:*[[Dementia]] | :*[[Dementia]]<ref name="ThomasHestermann2008">{{cite journal|last1=Thomas|first1=C|last2=Hestermann|first2=U|last3=Walther|first3=S|last4=Pfueller|first4=U|last5=Hack|first5=M|last6=Oster|first6=P|last7=Mundt|first7=C|last8=Weisbrod|first8=M|title=Prolonged activation EEG differentiates dementia with and without delirium in frail elderly patients|journal=Journal of Neurology, Neurosurgery & Psychiatry|volume=79|issue=2|year=2008|pages=119–125|issn=0022-3050|doi=10.1136/jnnp.2006.111732}}</ref> | ||
:*[[Non‑convulsive status epilepticus]] and [[temporal lobe]] [[epilepsy]] | :*[[Non‑convulsive status epilepticus]] and [[temporal lobe]] [[epilepsy]] | ||
*[[Conditions]] that can be identified on [[EEG]] include: | *[[Conditions]] that can be identified on [[EEG]] include: | ||
:*[[ metabolic encephalopathy]] or [[infectious encephalitis]] | :*[[ metabolic encephalopathy]] or [[infectious encephalitis]] | ||
:*Focal [[intracranial]] lesion, or it's a global abnormality. | :*Focal [[intracranial]] lesion, or it's a global abnormality. | ||
* | * [[EEG]] findings associated with [[delirium]] include:<ref name="KimchiNeelagiri2019">{{cite journal|last1=Kimchi|first1=Eyal Y.|last2=Neelagiri|first2=Anudeepthi|last3=Whitt|first3=Wade|last4=Sagi|first4=Avinash Rao|last5=Ryan|first5=Sophia L.|last6=Gadbois|first6=Greta|last7=Groothuysen|first7=Daniël|last8=Westover|first8=M. Brandon|title=Clinical EEG slowing correlates with delirium severity and predicts poor clinical outcomes|journal=Neurology|volume=93|issue=13|year=2019|pages=e1260–e1271|issn=0028-3878|doi=10.1212/WNL.0000000000008164}}</ref> | ||
* | |||
:*[[Periodic discharges]] | |||
:* Triphasic waves | |||
:* lateralized [[rhythmic]] delta | |||
:* Low voltage/generalized attenuation | |||
:* Theta or delta generalized slowing | |||
* The presence of either theta or delta generalized slowing correlated strongly with [[delirium]] severity regardless of [[arousal]] state (hyper- or hypoactive) and [[comorbidities]]. | |||
* [[EEG]] changes in [[delirium]] are most prominent in the posterior regions. | * [[EEG]] changes in [[delirium]] are most prominent in the posterior regions. | ||
* [[Delirium]] shows slowing of background activity, however, slowing of background activity is also observed in deep [[sleep]] and [[dementia]]. | * [[Delirium]] shows slowing of background activity, however, slowing of background activity is also observed in deep [[sleep]] and [[dementia]]. | ||
* | *Typical and atypical [[antipsychotic]] may cause [[EEG]] abnormality.<ref name="YılmazErbaş2013">{{cite journal|last1=Yılmaz|first1=Mustafa|last2=Erbaş|first2=Oytun|title=The effects of typical and atypical antipsychotics on the electrical activity of the brain in a rat model|journal=Journal of Clinical and Experimental Investigations|volume=4|issue=3|year=2013|issn=13096621|doi=10.5799/ahinjs.01.2013.03.0284}}</ref> | ||
* One study observed an increase in the relative power of the theta and a decline in the relative power of the alpha frequency band, but this phenomenon seen to be absent when [[Parkinson]] is a co-morbid [[condition]] to [[delirium]].<ref name="CozacGschwandtner2016">{{cite journal|last1=Cozac|first1=Vitalii V.|last2=Gschwandtner|first2=Ute|last3=Hatz|first3=Florian|last4=Hardmeier|first4=Martin|last5=Rüegg|first5=Stephan|last6=Fuhr|first6=Peter|title=Quantitative EEG and Cognitive Decline in Parkinson’s Disease|journal=Parkinson's Disease|volume=2016|year=2016|pages=1–14|issn=2090-8083|doi=10.1155/2016/9060649}}</ref> | |||
* One study observed an increase in the relative power of the theta and a decline in the relative power of the alpha frequency band, but this phenomenon seen to be absent when [[Parkinson]] is a co-morbid [[condition]] to [[delirium]]. | |||
* [[Delirium]] can also be identified from non [[delirium]] states by the following characteristics: | * [[Delirium]] can also be identified from non [[delirium]] states by the following characteristics: | ||
:* Increase in the relative power of the delta frequency band | :* Increase in the relative power of the delta frequency band | ||
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* [[Delirium]] has been known to be associated with a generalised slowing of background activity.<ref>{{cite journal|last=Engel|first=GL|coauthors=Romano, J|title=Delirium, a syndrome of cerebral insufficiency. 1959.|journal=The Journal of neuropsychiatry and clinical neurosciences|date=2004 Fall|volume=16|issue=4|pages=526–38|pmid=15616182|doi=10.1176/appi.neuropsych.16.4.526}}</ref><ref>{{cite journal|last=van der Kooi|first=AW|coauthors=Leijten, FS; van der Wekken, RJ; Slooter, AJ|title=What are the opportunities for EEG-based monitoring of delirium in the ICU?|journal=The Journal of neuropsychiatry and clinical neurosciences|date=2012 Fall|volume=24|issue=4|pages=472–7|pmid=23224454|doi=10.1176/appi.neuropsych.11110347}}</ref> | * [[Delirium]] has been known to be associated with a generalised slowing of background activity.<ref>{{cite journal|last=Engel|first=GL|coauthors=Romano, J|title=Delirium, a syndrome of cerebral insufficiency. 1959.|journal=The Journal of neuropsychiatry and clinical neurosciences|date=2004 Fall|volume=16|issue=4|pages=526–38|pmid=15616182|doi=10.1176/appi.neuropsych.16.4.526}}</ref><ref>{{cite journal|last=van der Kooi|first=AW|coauthors=Leijten, FS; van der Wekken, RJ; Slooter, AJ|title=What are the opportunities for EEG-based monitoring of delirium in the ICU?|journal=The Journal of neuropsychiatry and clinical neurosciences|date=2012 Fall|volume=24|issue=4|pages=472–7|pmid=23224454|doi=10.1176/appi.neuropsych.11110347}}</ref> | ||
* The relative power of the theta frequency and alpha frequencies was consistently different between [[delirium ]] and non-[[delirium]] [[patients]]. | |||
* The relative power of the theta frequency was consistently different between [[delirium ]]and non-[[delirium]] [[patients | |||
===[[Lumbar puncture]]=== | ===[[Lumbar puncture]]=== | ||
*Routine [[LP]] does not provide any benefit in management of [[delirium]]. However,it maybe helpful in suspected [[meningitis]] when [[ | *Routine [[LP]] does not provide any benefit in management of [[delirium]]. However,it maybe helpful in suspected [[meningitis]] when [[confusion]] is accompanied with:<ref name="Warshaw1993">{{cite journal|last1=Warshaw|first1=G.|title=The effectiveness of lumbar puncture in the evaluation of delirium and fever in the hospitalized elderly|journal=Archives of Family Medicine|volume=2|issue=3|year=1993|pages=293–297|issn=10633987|doi=10.1001/archfami.2.3.293}}</ref> | ||
* [[Meningism]] | * [[Meningism]] | ||
* [[Headache]] and [[fever]] | * [[Headache]] and [[fever]] | ||
Latest revision as of 09:27, 22 April 2021
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Delirium On the Web |
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American Roentgen Ray Society Images of Delirium |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Pratik Bahekar, MBBS [3]; Vishal Khurana, M.B.B.S., M.D. [4]
Overview
EEG maybe helpful for the diagnosis of delirium. EEG findings associated with delirium include periodic discharges, triphasic waves ,lateralized rhythmic delta ,low voltage/generalized attenuation, theta or delta generalized slowing.The presence of either theta or delta generalized slowing correlated strongly with delirium severity regardless of arousal state (hyper- or hypoactive) and comorbidities.
Other Diagnostic Studies
- EEG
- Lumbar Puncture
EEG
- EEG shows diffuse slowing which is an indicator of delirium severity.[1]
- EEG is useful to differentiate delirium from following conditions:
- Conditions that can be identified on EEG include:
- metabolic encephalopathy or infectious encephalitis
- Focal intracranial lesion, or it's a global abnormality.
- Periodic discharges
- Triphasic waves
- lateralized rhythmic delta
- Low voltage/generalized attenuation
- Theta or delta generalized slowing
- The presence of either theta or delta generalized slowing correlated strongly with delirium severity regardless of arousal state (hyper- or hypoactive) and comorbidities.
- EEG changes in delirium are most prominent in the posterior regions.
- Delirium shows slowing of background activity, however, slowing of background activity is also observed in deep sleep and dementia.
- Typical and atypical antipsychotic may cause EEG abnormality.[3]
- One study observed an increase in the relative power of the theta and a decline in the relative power of the alpha frequency band, but this phenomenon seen to be absent when Parkinson is a co-morbid condition to delirium.[4]
- Delirium can also be identified from non delirium states by the following characteristics:
- Increase in the relative power of the delta frequency band
- Decrease in the peak frequency and significantly decreased bispectral index (BIS).[5]
- Delirium has been known to be associated with a generalised slowing of background activity.[6][7]
- The relative power of the theta frequency and alpha frequencies was consistently different between delirium and non-delirium patients.
Lumbar puncture
- Routine LP does not provide any benefit in management of delirium. However,it maybe helpful in suspected meningitis when confusion is accompanied with:[8]
References
- ↑ 1.0 1.1 Kimchi, Eyal Y.; Neelagiri, Anudeepthi; Whitt, Wade; Sagi, Avinash Rao; Ryan, Sophia L.; Gadbois, Greta; Groothuysen, Daniël; Westover, M. Brandon (2019). "Clinical EEG slowing correlates with delirium severity and predicts poor clinical outcomes". Neurology. 93 (13): e1260–e1271. doi:10.1212/WNL.0000000000008164. ISSN 0028-3878.
- ↑ Thomas, C; Hestermann, U; Walther, S; Pfueller, U; Hack, M; Oster, P; Mundt, C; Weisbrod, M (2008). "Prolonged activation EEG differentiates dementia with and without delirium in frail elderly patients". Journal of Neurology, Neurosurgery & Psychiatry. 79 (2): 119–125. doi:10.1136/jnnp.2006.111732. ISSN 0022-3050.
- ↑ Yılmaz, Mustafa; Erbaş, Oytun (2013). "The effects of typical and atypical antipsychotics on the electrical activity of the brain in a rat model". Journal of Clinical and Experimental Investigations. 4 (3). doi:10.5799/ahinjs.01.2013.03.0284. ISSN 1309-6621.
- ↑ Cozac, Vitalii V.; Gschwandtner, Ute; Hatz, Florian; Hardmeier, Martin; Rüegg, Stephan; Fuhr, Peter (2016). "Quantitative EEG and Cognitive Decline in Parkinson's Disease". Parkinson's Disease. 2016: 1–14. doi:10.1155/2016/9060649. ISSN 2090-8083.
- ↑ "What are the opportunities f... [J Neuropsychiatry Clin Neurosci. 2012] - PubMed - NCBI".
- ↑ Engel, GL (2004 Fall). "Delirium, a syndrome of cerebral insufficiency. 1959". The Journal of neuropsychiatry and clinical neurosciences. 16 (4): 526–38. doi:10.1176/appi.neuropsych.16.4.526. PMID 15616182. Unknown parameter
|coauthors=ignored (help); Check date values in:|date=(help) - ↑ van der Kooi, AW (2012 Fall). "What are the opportunities for EEG-based monitoring of delirium in the ICU?". The Journal of neuropsychiatry and clinical neurosciences. 24 (4): 472–7. doi:10.1176/appi.neuropsych.11110347. PMID 23224454. Unknown parameter
|coauthors=ignored (help); Check date values in:|date=(help) - ↑ Warshaw, G. (1993). "The effectiveness of lumbar puncture in the evaluation of delirium and fever in the hospitalized elderly". Archives of Family Medicine. 2 (3): 293–297. doi:10.1001/archfami.2.3.293. ISSN 1063-3987.