Delirium physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vishal Khurana, M.B.B.S., M.D. [2]; Pratik Bahekar, MBBS [3]

Overview

It is important to do a thorough physical examination to find out the underlying etiology of delirium.

Physical Examination

Delirium symptom changes in severity during it's course. It's essential to assess patient multiple times, as it's easy to miss diagnosis, especially features like sundowning.

• General examination
• Systemic examination

General examination

• Vitals
• Conscious level
• Cognitive function using a standardied screening tool, e.g. MOCA, MMSE
• Nutritional status
• Hydration state
• Infectious foci
• Evidence of alcohol abuse or withdrawal (e.g. tremor)

Systemic examination

• Neurological examinations: Careful examination must be done to find out neurological causes of delirium, such as cerebrovascular diseases, neurodegenrative disorders such as parkinsonism, alzhimers, and lewi body dementia etc. Many systemic diseases may show neurological manifestations such as hepatic encephalopathy causes asterexis and flapping tremors. Overdose and intoxication can also effect the central nervous system, e.g. opiates causes pin point pupils, and respiratory depression.