Approach To Decreased LOC

Question 1

I WATCH DEATH

Answer 1

Infection
Withdrawal 
Acute metabolic 
Trauma
CNS causes
Hypoxia
Deficiencies ( nutritional)
Endocrinopathies 
Acute vascular 
Toxins/drugs
Heavy metals

Question 2

Outline the diagnostic criteria for delirium

Answer 2

Disturbances in consciousness, memory, cognition, and perception, developing over a short time, fluctuates, and is secondary to a medical condition

Question 3

List 6 predisposing factors for delirium.

Answer 3

1. Old age (>70)
2. Dementia
3. Multiple medications
4. Drugs and EtOH
5. Medical illness
6. Females > Males
7. Caucasian
8. Sleep deprivation
9. Psychological stress
   Sensory impairment

Question 4

What medications can precipitate delirium (esp in those at higher risk)?

Answer 4

1. Antibiotics
2. Anticholinergics
3. Anticonvulsants
4. Anti-inflammatory
5. Cardiac drugs
6. Sympathomimetics
7. Sedative hypnotics
8. Plants
9. Miscellaneous

Question 5

What specific etiologies of delirium must be considered in the HIV patient?

Answer 5

· HIV dementia
· Infectious
	o Toxoplasmosis
	o Cryptococcus
	o CMV
	o HSV
· Neoplastic
	o Lymphoma
· Medications

Question 6

What specific etiologies of delirium must be considered in the elderly?

Answer 6

· Infectious
	o UTI
	o Pneumonia
· Med interaction
	o Altered pharmacokinetics 
· Ischemic
	o MI ® CHF
	o Bowel
· Diet/personal care
	o Hypovolemia
	o ¯Na
	o Malnutrition
· EtOH and withdrawal
· Sensory deficits
	o Vision
Hearing

Question 7

What viruses can cause dementia?

Answer 7

• Panencephalitis: measles
• Progressive multifocal leukoencephalopathy à JC virus (parvovirus)
• Rubella encephalitis
• HIV: AIDS dementia complex
• Cretzfeld-Jacob

Question 8

What is the classic triad of normal pressure hydrocephalus?

Answer 8

1. Progressive cognitive decline
2. Urinary incontinence
3. Ataxia