Acute confusional state; Acute brain syndrome

Delirium involves a quick change between mental states (for example, from lethargy to agitation and back to lethargy).

Symptoms include:

• Changes in alertness (usually more alert in the morning, less alert at night)
• Changes in feeling (sensation) and perception
• Changes in level of consciousness or awareness
• Changes in movement (for example, may be slow moving or hyperactive)
• Changes in sleep patterns, drowsiness
• Confusion (disorientation) about time or place
• Decrease in short-term memory and recall
  • Unable to remember events since delirium began (anterograde amnesia)
  • Unable to remember events before delirium (retrograde amnesia)
• Disrupted or wandering attention
  • Inability to think or behave with purpose
  • Problems concentrating
• Disorganized thinking
  • Speech that doesn't make sense (incoherent)
  • Inability to stop speech patterns or behaviors
• Emotional or personality changes
  • Anger
  • Agitation
  • Anxiety
  • Apathy
  • Depression
  • Euphoria
  • Irritability
• Incontinence
• Movements triggered by changes in the nervous system (psychomotor restlessness)

The following tests may have abnormal results:

• An exam of the nervous system (neurologic examination), including tests of feeling (sensation), thinking (cognitive function), and motor function
• Neuropsychological studies

The following tests may also be done:

• Ammonia levels in the blood
• Blood chemistry (comprehensive metabolic panel)
• Blood gas analysis
• Chest x-ray
• Cerebrospinal fluid (CSF) analysis
• Creatine kinase level in blood
• Drug, alcohol levels (toxicology screen)
• Electroencephalogram (EEG)
• Head CT scan
• Head MRI scan
• Liver function tests
• Mental status test
• Serum magnesium
• Thyroid function tests
• Urinalysis
• Vitamin B1 and B12 levels

Images

Central nervous system

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Delirium Overview

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Delirium Treatment

Review Date: 02/06/2010
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Luc Jasmin, MD, PhD, Department of Neurolosurgery, Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)