Confusion pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Confusion results from global impairment of function of brain. Few areas of brain are identified for various presentations of confusion. Drugs, poisons, chemicals interact with the neurotransmitters and cause confusion. Inflammatory agents are involved in conditions like fever.

Pathophysiology

Confusion is commonly used term for any altered mental status, inability to pay attention or making decisions. Confusion is seen in various conditions and caused by many drugs and poisons. Various theories are postulated for development of confusion.

• Lesions involving the ascending reticular activating system causes disturbance in arousal.

• Lesions involving non-dominant frontal and parietal lobes causes disturbance in attention.

• Lesions of the cortex will cause disturbance in insight and judgement capacity of the individual.

Delirium is a type of confusional state which develops suddenly and causes rapid changes in brain function.

• Disturbance in global function of brain leads to delirium. It is valid for the confusion caused by various kinds of drugs and poisons.

• Certain diseases and strokes cause confusion.There are evidences to support sub cortical mechanism for confusion.

• Certain drugs have anticholinergic properties which at higher doses or in elderly can impair brain function.

• In conditions like fever, post surgical recovery states cytokine activation may be the cause for confusion

• Certain metabolic states like hypoglycemia, electrolyte abnormalities, hypoxia cause global dysfunction of brain function leading to confusion.