Confusion overview: Difference between revisions
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===MRI=== | ===MRI=== | ||
MRI scan is more sensitive in identifying intra cranial lesions than CT scan. It can be used in cases | An MRI scan is more sensitive in identifying intra cranial lesions than a CT scan. It can be used in cases with a high index of suspicion and a negative report on a CT scan. | ||
===Echocardiogram or Ultrasound=== | ===Echocardiogram or Ultrasound=== | ||
Revision as of 16:15, 7 February 2013
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Confusion Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Confusion overview On the Web |
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American Roentgen Ray Society Images of Confusion overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]
Overview
Confusion refers to mental dysfunction in which a lack of attention and disorientation occurs with the inability to think with normal speed or clarity. It is the inability to maintain a coherent stream of thought or action.
Pathophysiology
Confusion results from global impairment of brain functions. Some areas of the brain are identified for various presentations of confusion. Drugs, poisons, and chemicals interact with the neurotransmitters and can cause confusion. Inflammatory agents are involved in conditions such as a fever.
Causes
Confusion is a common symptom associated with various diseases and metabolic disorders. Common causes of confusion include insults to the central nervous system (CNS), metabolic disorders, and side effects of medications or illicit drugs.
Differentiating Confusion from other Diseases
Various conditions such as dementia, depression and amnesia involve confusion as part of their presentation. Obtaining a clear history about the onset of symptoms, and the onset of confusion in association with other symptoms, helps in differentiating confusion from other conditions.
Epidemiology and Demographics
Nearly about 30% of older patients admitted for medical conditions are confused at some point of time during their admission.[1] In surgical wards the chances of confusion ranges from 10-50%.[2] Increasing rates are seen in patients admitted to intensive care units and in hospice care. There is no significant difference in the distribution based upon gender or race.
Risk Factors
Increasing age, admission to the hospital, post-surgical status, alcoholism, and underlying brain lesions are a few important risk factors for confusion. Special care is required for elderly patients who are hospitalized.
Natural History, Complications and Prognosis
Confusion is a disturbance in mental status which develops rapidly. If untreated it develops into a stupor / coma. Confusion caused by metabolic changes can be rapidly corrected and have good prognosis compared to the one caused by underlying structural abnormalities of the brain. The mortality rate for those who developed confusion at a hospital is nearly 39% in the first year which is nearly twice compared to age matched controls.[3]
Diagnosis
History and Symptoms
Confused patients will not be able to provide a coherent history. Confirming the history with a patient’s caregiver is the key to obtaining an accurate history about the patient. Determining the patient’s drug history and co morbid conditions is very important. In young patients drug abuse and withdrawal should be evaluated. Some assessment scales are used to identify and diagnose confusion, and they include the Confusion Assessment Method, Mini Mental Status Examination, and The Neelon and Champagne (NEECHAM) Confusion Scale.
Physical Examination
In cases of confusion, a physical examination helps in localizing the lesion if the cause is from the brain. It also gives clues to the underlying cause of the disease. A complete neurological examination may not be done due to a limitation of patient's condition.
Laboratory Findings
Several laboratory tests are available for evaluating confusion. It is a physician's role to choose the most useful test based upon the history of the person. For example, a patient presenting with confusion, severe neck stiffness, headaches, and fever should be evaluated for infective foci.
Electrocardiogram
Various heart conditions can cause hypoperfusion of the brain. This hypoperfusion can be a cause of confusion. An electrocardiogram can help to identify any associated heart conduction problems, which helps in the diagnosis.
Chest X Ray
Lung pathologies usually cause hypoxia and confusion if left untreated. A chest x ray is the most important tool to evaluate such conditions. It can be very helpful in identifying various lung lesions and infections.
CT
A CT scan of the head is an important diagnostic tool in cases of confusion where a cause couldn't be established. Before a lumbar puncture is done, a CT scan is the first test used in cases of suspected infections such as meningitis.
MRI
An MRI scan is more sensitive in identifying intra cranial lesions than a CT scan. It can be used in cases with a high index of suspicion and a negative report on a CT scan.
Echocardiogram or Ultrasound
Echocardiogram is a valuable tool to asses the cardiac output. It helps in determining the perfusion. Ultrasound is used for determining the cause of confusion in certain abdominal conditions like any liver injuries, bleeds in to abdomen, injury to major vessels in abdomen.
Other Imaging Findings
There are several other imaging studies which are not quite that often used for diagnosis. They are mostly used in cases of unconfirmed diagnosis. Few of them are CT angiography,FLAIR(Fluid attenuated inversion recovery images.
Other Diagnostic Studies
Certain studies like electroencephalography(EEG) are of noticeable importance. These tests are done to exclude other differential diagnosis and aid in diagnosis of certain conditions.
Treatment
Medical Therapy
Complete evaluation of the person in emergency department has to be done and appropriate treatment is administered. Every confused individual should be administered with glucose and thiamine, followed by naloxone and flumazenil. Treatment must be started awaiting results. Early treatment can save the individual from long term effects.
Surgery
Surgical options are limited for confusion. It all depends on the cause of confusion. Few conditions like sub dural hematoma which can be drained are surgically evacuated. In such cases consultation with neurosurgery may be needed. In cases of road traffic accidents , person may be bleeding severely due to fractures and visceral injury. In such cases consult with orthopedics and surgery.
References
- ↑ Francis J (1992). "Delirium in older patients". J Am Geriatr Soc. 40 (8): 829–38. PMID 1634729. Unknown parameter
|month=ignored (help) - ↑ Dyer CB, Ashton CM, Teasdale TA (1995). "Postoperative delirium. A review of 80 primary data-collection studies". Arch. Intern. Med. 155 (5): 461–5. PMID 7864702. Unknown parameter
|month=ignored (help) - ↑ Inouye SK, Charpentier PA (1996). "Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability". JAMA. 275 (11): 852–7. PMID 8596223. Unknown parameter
|month=ignored (help)