Capsule cases Flashcards
(32 cards)
Features of delirium
Not eating
Sleeping constantly
No lucid conversations
What are the two forms of delirium
Hyperactive
Hypoactive
Mixed
What functions of the brain is affected in delirium?
Disturbance of brain leading to: Changes in altertness Attention Perception (incl. paranoia) Cognitive function Behaviour Physical function Sleep cycle
What proportion of patients on the wards have delirium?
1/5 on general wards
1/3 on gerries wards
Pathophysiology/what we know
No idea but EEG show cortical slowing
Might be due to inflammation, chronic stress, neurotransmission
Predisposing conditions for delirium?
Visual impairment Hearing impairment Dehydration Pain Age Decreased oral intake Coexisting medical conditions Drugs Cognitive status
What might precipitate a delirium?
Pain New environment Anaesthesia Dehydration Disturbed sleep Electrolyte disturbances Infection Surgery Cardioresp/neuro? Constipation Endocrine/metabolic thigs
History
Collateral hx Is the confusion is a new phenomenon? Hx of incontinence Full drug hx? Use of glasses/hearing aids SH
Bedside examinations
GCS Temp Signs of infection Full system examination, including PR Pressure sores and pain AMTS or MMSE or MOCA
Investigations for acute delirium
Pulse oximetry BP Urinalysis FBC Renal profile Calcium LFTs Glucose Blood cultures ABGs ECG CXR CRP
What do you test lumbar puncture for?
Protein
Glucose (plasma and CSF)
WCC
Gram stain
Headache plus delirium - what tests do you do?
CT head
LP
What is the difference in appearance, WCC, glucose and protein of CSF between bacteria and viruses?
Bacterial - cloudy
Viral - normal
Bacterial - neutrophils high
Viral - lymphocytes high
Protein high in bacteria
Normal or high in viral
Glucose low in bacteria
Normal or low in viral
Characteristic features of Frontotemporal dementia
Disinhibition
Characteristic features of vascular dementia
Focal neurological signs
stepwise deterioration
Characteristic features of Alzheimers dementia
Difficulty naming recent things
Three types of rapidly progressive dementia
Creutzfeld-Jakob disease
Lewy body dementia
Frontal temporal dementia
Three types of fixed impairment demenita
Traumatic brain injury
Anoxic brain injury
Post infection
Progressive dementia
Alzheimers
Vascular
What two investigations must you do to rule out reversible causes of dementia?
TFTs - hypothyroidism can cause myxoedema coma
Vit B12
CT head
What would you see in CSF if the pt has GBS?
Protein is high
Everything else normal
What would you see in CSF if the pt has GBS?
Protein is high
Everything else normal
What would you see in CSF if the pt has SAH ?
Blood stained CSF
Everything else normal but protein may be high
A CT scan looks like there’s no gyri. What might be the issue?
Bilateral subdurals - subacute
Isodense
