Delirium other diagnostic studies: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
 
(23 intermediate revisions by the same user not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Delirium}}
{{Delirium}}
{{CMG}}; {{AE}} {{PB}}; [[User:Vishal Khurana|Vishal Khurana]], M.B.B.S., M.D. [mailto:vishdoc24@gmail.com]
{{CMG}}; {{AE}} {{Sara.Zand}} {{PB}}; [[User:Vishal Khurana|Vishal Khurana]], M.B.B.S., M.D. [mailto:vishdoc24@gmail.com]


==Overview==
==Overview==
[[EEG]] and [[Lumbar puncture]] can be utilized in the management of delirium, however they are not always indicated.
[[EEG]] maybe helpful for the diagnosis of [[delirium]].  [[EEG]] findings associated with [[delirium]] include [[periodic discharges]], triphasic waves ,lateralized [[rhythmic]] delta ,low voltage/generalized attenuation, theta or delta generalized slowing.The presence of either theta or delta generalized slowing correlated strongly with [[delirium]] severity regardless of [[arousal]] state (hyper- or hypoactive) and [[comorbidities]].
 
==Other Diagnostic Studies==
==Other Diagnostic Studies==
# '''EEG'''
# '''EEG'''
# '''Lumbar Puncture'''
# '''Lumbar Puncture'''
===EEG===
===EEG===
[[EEG]] shows diffuse slowing. [[EEG]] is useful to differentiate delirium from following conditions:
* [[EEG]] shows diffuse slowing which is an indicator of [[delirium]] severity.<ref name="KimchiNeelagiri2019">{{cite journal|last1=Kimchi|first1=Eyal Y.|last2=Neelagiri|first2=Anudeepthi|last3=Whitt|first3=Wade|last4=Sagi|first4=Avinash Rao|last5=Ryan|first5=Sophia L.|last6=Gadbois|first6=Greta|last7=Groothuysen|first7=Daniël|last8=Westover|first8=M. Brandon|title=Clinical EEG slowing correlates with delirium severity and predicts poor clinical outcomes|journal=Neurology|volume=93|issue=13|year=2019|pages=e1260–e1271|issn=0028-3878|doi=10.1212/WNL.0000000000008164}}</ref>
*Dementia
* [[EEG]] is useful to differentiate [[delirium]] from following [[conditions]]:
*Non‑convulsive status epilepticus and temporal lobe [[epilepsy]]
:*[[Dementia]]<ref name="ThomasHestermann2008">{{cite journal|last1=Thomas|first1=C|last2=Hestermann|first2=U|last3=Walther|first3=S|last4=Pfueller|first4=U|last5=Hack|first5=M|last6=Oster|first6=P|last7=Mundt|first7=C|last8=Weisbrod|first8=M|title=Prolonged activation EEG differentiates dementia with and without delirium in frail elderly patients|journal=Journal of Neurology, Neurosurgery & Psychiatry|volume=79|issue=2|year=2008|pages=119–125|issn=0022-3050|doi=10.1136/jnnp.2006.111732}}</ref>
*Conditions that can be identified on EEG e.g. metabolic encephalopathy or infectious encephalitis
:*[[Non‑convulsive status epilepticus]] and [[temporal lobe]] [[epilepsy]]
*Focal intracranial lesion, or it's a global abnormality.
*[[Conditions]] that can be identified on [[EEG]] include:
As exact [[EEG]] changes in delirium are yet to be identified, EEG is not used to diagnose delirium. Identification of the most informative electrode, and use of fewer electrodes will increase the usefulness of [[EEG]] in delirium. Continuous [[EEG]] monitoring has proven to be a feasible approach in the management of [[Epilepsy]], therefore [[EEG]] beholds a great potential to improve detection rates of delirium. [[EEG]] changes in delirium are most prominent in the posterior regions. Delirium shows slowing of background activity, however, slowing of background activity is also observed in deep sleep and dementia.  [[EEG]] recording of sleep shows K complexes and sleep-spindles whereas [[EEG]] recorded with eyes open (active [[EEG]]) in delirium have the relative power in the delta and the upper half of the alpha frequency band significantly different from dementia. These differences can be exploited to differentiate delirium from sleep and [[dementia]]. 
:*[[ metabolic encephalopathy]] or [[infectious encephalitis]]
There are many practical limitations of [[EEG]] studies in delirium. The exact effects of drugs like [[haloperidol]] on [[EEG]] are unknown, this poses a problem to study [[EEG]] characteristics of delirium, as [[haloperidol]] is the most widely used medicines in the management of delirium. Also, because of the very fluctuating nature of delirium, many studies suffer from time gap between diagnosis of delirium and [[EEG]] recordings.
:*Focal [[intracranial]] lesion, or it's a global abnormality.
Most studies have noticed difference in the relative power of the theta frequency in delirium and non-delirium patients. However, some studies have found this relative difference in theta frequency was restricted to the lower part and these studies failed to observe any difference in the higher part of the theta frequency.  One study observed an increase in the relative power of the theta and a decline in the relative power of the alpha frequency band, but this phenomenon seen to be absent when Parkinson is a co-morbid condition to delirium. More work needs to be done on the theta, alpha and delta waves as many studies have disputed given findings. Delirium can also be identified from non delirium states by the following characteristics, as delirium shows an increase in the relative power of the delta frequency band, a decreased in the peak frequency and significantly decreased bispectral index (BIS).<ref>{{Cite web  | last =  | first =  | title = What are the opportunities f... [J Neuropsychiatry Clin Neurosci. 2012] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/23224454 | publisher =  | date =  | accessdate = }}</ref>
* [[EEG]] findings associated with [[delirium]] include:<ref name="KimchiNeelagiri2019">{{cite journal|last1=Kimchi|first1=Eyal Y.|last2=Neelagiri|first2=Anudeepthi|last3=Whitt|first3=Wade|last4=Sagi|first4=Avinash Rao|last5=Ryan|first5=Sophia L.|last6=Gadbois|first6=Greta|last7=Groothuysen|first7=Daniël|last8=Westover|first8=M. Brandon|title=Clinical EEG slowing correlates with delirium severity and predicts poor clinical outcomes|journal=Neurology|volume=93|issue=13|year=2019|pages=e1260–e1271|issn=0028-3878|doi=10.1212/WNL.0000000000008164}}</ref>
===Lumbar puncture===
 
Routine LP does not provide any benefit in management of delirium. However,it's helpful in suspected meningitis, i.e. delirium with
:*[[Periodic discharges]]
:* Triphasic waves
:* lateralized [[rhythmic]] delta
:* Low voltage/generalized attenuation
:* Theta or delta generalized slowing
* The presence of either theta or delta generalized slowing correlated strongly with [[delirium]] severity regardless of [[arousal]] state (hyper- or hypoactive) and [[comorbidities]].
* [[EEG]] changes in [[delirium]] are most prominent in the posterior regions.  
* [[Delirium]] shows slowing of background activity, however, slowing of background activity is also observed in deep [[sleep]] and [[dementia]].
*Typical and atypical [[antipsychotic]] may cause [[EEG]] abnormality.<ref name="YılmazErbaş2013">{{cite journal|last1=Yılmaz|first1=Mustafa|last2=Erbaş|first2=Oytun|title=The effects of typical and atypical antipsychotics on the electrical activity of the brain in a rat model|journal=Journal of Clinical and Experimental Investigations|volume=4|issue=3|year=2013|issn=13096621|doi=10.5799/ahinjs.01.2013.03.0284}}</ref>
   
* One study observed an increase in the relative power of the theta and a decline in the relative power of the alpha frequency band, but this phenomenon seen to be absent when [[Parkinson]] is a co-morbid [[condition]] to [[delirium]].<ref name="CozacGschwandtner2016">{{cite journal|last1=Cozac|first1=Vitalii V.|last2=Gschwandtner|first2=Ute|last3=Hatz|first3=Florian|last4=Hardmeier|first4=Martin|last5=Rüegg|first5=Stephan|last6=Fuhr|first6=Peter|title=Quantitative EEG and Cognitive Decline in Parkinson’s Disease|journal=Parkinson's Disease|volume=2016|year=2016|pages=1–14|issn=2090-8083|doi=10.1155/2016/9060649}}</ref>
* [[Delirium]] can also be identified from non [[delirium]] states by the following characteristics:
:* Increase in the relative power of the delta frequency band
:* Decrease in the peak frequency and significantly decreased bispectral index (BIS).<ref>{{Cite web  | last =  | first =  | title = What are the opportunities f... [J Neuropsychiatry Clin Neurosci. 2012] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/23224454 | publisher =  | date =  | accessdate = }}</ref>
 
 
 
* [[Delirium]] has been known to be associated with a generalised slowing of background activity.<ref>{{cite journal|last=Engel|first=GL|coauthors=Romano, J|title=Delirium, a syndrome of cerebral insufficiency. 1959.|journal=The Journal of neuropsychiatry and clinical neurosciences|date=2004 Fall|volume=16|issue=4|pages=526–38|pmid=15616182|doi=10.1176/appi.neuropsych.16.4.526}}</ref><ref>{{cite journal|last=van der Kooi|first=AW|coauthors=Leijten, FS; van der Wekken, RJ; Slooter, AJ|title=What are the opportunities for EEG-based monitoring of delirium in the ICU?|journal=The Journal of neuropsychiatry and clinical neurosciences|date=2012 Fall|volume=24|issue=4|pages=472–7|pmid=23224454|doi=10.1176/appi.neuropsych.11110347}}</ref>
* The relative power of the theta frequency and alpha frequencies was consistently different between [[delirium ]] and non-[[delirium]] [[patients]].
 
===[[Lumbar puncture]]===
*Routine [[LP]] does not provide any benefit in management of [[delirium]]. However,it maybe helpful in suspected [[meningitis]] when [[confusion]] is accompanied with:<ref name="Warshaw1993">{{cite journal|last1=Warshaw|first1=G.|title=The effectiveness of lumbar puncture in the evaluation of delirium and fever in the hospitalized elderly|journal=Archives of Family Medicine|volume=2|issue=3|year=1993|pages=293–297|issn=10633987|doi=10.1001/archfami.2.3.293}}</ref>
 
* [[Meningism]]
* [[Meningism]]
* [[Headache]] and fever<ref>{{Cite web  | last =  | first =  | title = http://www.bgs.org.uk/Word%20Downloads/delirium.doc | url = http://www.bgs.org.uk/Word%20Downloads/delirium.doc | publisher =  | date =  | accessdate =}}</ref>
* [[Headache]] and [[fever]]
 
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 09:27, 22 April 2021

Delirium Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Delirium from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

CT

MRI

Other Diagnostic Studies

Treatment

Medical Therapy

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case #1

Delirium On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Delirium

All Images
X-rays
Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Delirium

CDC on Delirium

Delirium in the news

Blogs on Delirium

Directions to Hospitals Treating Delirium

Risk calculators and risk factors for Delirium

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Pratik Bahekar, MBBS [3]; Vishal Khurana, M.B.B.S., M.D. [4]

Overview

EEG maybe helpful for the diagnosis of delirium. EEG findings associated with delirium include periodic discharges, triphasic waves ,lateralized rhythmic delta ,low voltage/generalized attenuation, theta or delta generalized slowing.The presence of either theta or delta generalized slowing correlated strongly with delirium severity regardless of arousal state (hyper- or hypoactive) and comorbidities.

Other Diagnostic Studies

  1. EEG
  2. Lumbar Puncture

EEG

  • The presence of either theta or delta generalized slowing correlated strongly with delirium severity regardless of arousal state (hyper- or hypoactive) and comorbidities.
  • EEG changes in delirium are most prominent in the posterior regions.
  • Delirium shows slowing of background activity, however, slowing of background activity is also observed in deep sleep and dementia.
  • Typical and atypical antipsychotic may cause EEG abnormality.[3]
  • One study observed an increase in the relative power of the theta and a decline in the relative power of the alpha frequency band, but this phenomenon seen to be absent when Parkinson is a co-morbid condition to delirium.[4]
  • Delirium can also be identified from non delirium states by the following characteristics:
  • Increase in the relative power of the delta frequency band
  • Decrease in the peak frequency and significantly decreased bispectral index (BIS).[5]


  • Delirium has been known to be associated with a generalised slowing of background activity.[6][7]
  • The relative power of the theta frequency and alpha frequencies was consistently different between delirium and non-delirium patients.

Lumbar puncture

References

  1. ↑ 1.0 1.1 Kimchi, Eyal Y.; Neelagiri, Anudeepthi; Whitt, Wade; Sagi, Avinash Rao; Ryan, Sophia L.; Gadbois, Greta; Groothuysen, Daniël; Westover, M. Brandon (2019). "Clinical EEG slowing correlates with delirium severity and predicts poor clinical outcomes". Neurology. 93 (13): e1260–e1271. doi:10.1212/WNL.0000000000008164. ISSN 0028-3878.
  2. ↑ Thomas, C; Hestermann, U; Walther, S; Pfueller, U; Hack, M; Oster, P; Mundt, C; Weisbrod, M (2008). "Prolonged activation EEG differentiates dementia with and without delirium in frail elderly patients". Journal of Neurology, Neurosurgery & Psychiatry. 79 (2): 119–125. doi:10.1136/jnnp.2006.111732. ISSN 0022-3050.
  3. ↑ Yılmaz, Mustafa; Erbaş, Oytun (2013). "The effects of typical and atypical antipsychotics on the electrical activity of the brain in a rat model". Journal of Clinical and Experimental Investigations. 4 (3). doi:10.5799/ahinjs.01.2013.03.0284. ISSN 1309-6621.
  4. ↑ Cozac, Vitalii V.; Gschwandtner, Ute; Hatz, Florian; Hardmeier, Martin; Rüegg, Stephan; Fuhr, Peter (2016). "Quantitative EEG and Cognitive Decline in Parkinson's Disease". Parkinson's Disease. 2016: 1–14. doi:10.1155/2016/9060649. ISSN 2090-8083.
  5. ↑ "What are the opportunities f... [J Neuropsychiatry Clin Neurosci. 2012] - PubMed - NCBI".
  6. ↑ Engel, GL (2004 Fall). "Delirium, a syndrome of cerebral insufficiency. 1959". The Journal of neuropsychiatry and clinical neurosciences. 16 (4): 526–38. doi:10.1176/appi.neuropsych.16.4.526. PMID 15616182. Unknown parameter |coauthors= ignored (help); Check date values in: |date= (help)
  7. ↑ van der Kooi, AW (2012 Fall). "What are the opportunities for EEG-based monitoring of delirium in the ICU?". The Journal of neuropsychiatry and clinical neurosciences. 24 (4): 472–7. doi:10.1176/appi.neuropsych.11110347. PMID 23224454. Unknown parameter |coauthors= ignored (help); Check date values in: |date= (help)
  8. ↑ Warshaw, G. (1993). "The effectiveness of lumbar puncture in the evaluation of delirium and fever in the hospitalized elderly". Archives of Family Medicine. 2 (3): 293–297. doi:10.1001/archfami.2.3.293. ISSN 1063-3987.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Delirium_other_diagnostic_studies&oldid=1698093"