Delirium other diagnostic studies: Difference between revisions

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{{Delirium}}
{{Delirium}}
{{CMG}}; {{AE}} [[User:Vishal Khurana|Vishal Khurana]], M.B.B.S., M.D. [mailto:vishdoc24@gmail.com]
{{CMG}}; {{AE}} [[User:Vishal Khurana|Vishal Khurana]], M.B.B.S., M.D. [mailto:vishdoc24@gmail.com]; {{PB}}


==Overview==
==Overview==
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To identify underlying etiology following investigations are recommended:
To identify underlying etiology following investigations are recommended:


* Complete blood count
* Complete blood count
Line 28: Line 27:


'''If indicated:
'''If indicated:
** EEG
*EEG


** CT head
*CT head


** B12 and folate levels
*B12 and folate levels


** Arterial blood gases
*Arterial blood gases


** Specific cultures eg urine, sputum
*Specific cultures eg urine, sputum


** Lumbar puncture
*Lumbar puncture


===EEG===
===EEG===


Although the EEG is frequently abnormal in those with delirium [27‑29], showing diffuse slowing, its routine use as a diagnostic tool has not been fully evaluated. EEG may be useful where there is difficulty in the following situations (grade III):
EEG shows diffuse slowing. EEG is useful to differentiate delirium from following condtions:


·                    Differentiating delirium from dementia
*dementia


·                    Differentiating delirium from non‑convulsive status epilepticus and temporal lobe epilepsy
*non‑convulsive status epilepticus and temporal lobe epilepsy


·                    Identifying those patients in whom the delirium is due to a focal intracranial lesion, rather than a global abnormality.
*focal intracranial lesion, or it's a global abnormality.
 
EEG is not used to diagnose delirium.


===Lumbar puncture===
===Lumbar puncture===
 
Routine LP does not provide any benefit in management of delirium. However,it's helpful in suspected meningitis, ie delirium with
Although various abnormalities have been seen in the CSF of patients with delirium [30], routine LP is not helpful [31] in identifying an underlying cause for the delirium (grade III). It should therefore be reserved for those in whom there is reason to suspect a cause such as meningitis. This might include patients with the following features:
* 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>
·                    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>


==References==
==References==

Revision as of 18:34, 14 February 2014

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

Overview

Investigations

To identify underlying etiology following investigations are recommended:

  • Complete blood count
  • Serum Calcium
  • Kidney function tests
  • electrolytes
  • Liver function tests
  • Blood sugar level
  • Thyroid function tests
  • Chest X‑ray
  • ECG
  • Blood cultures
  • Urinalysis


If indicated:

  • EEG
  • CT head
  • B12 and folate levels
  • Arterial blood gases
  • Specific cultures eg urine, sputum
  • Lumbar puncture

EEG

EEG shows diffuse slowing. EEG is useful to differentiate delirium from following condtions:

  • dementia
  • non‑convulsive status epilepticus and temporal lobe epilepsy
  • focal intracranial lesion, or it's a global abnormality.

EEG is not used to diagnose delirium.

Lumbar puncture

Routine LP does not provide any benefit in management of delirium. However,it's helpful in suspected meningitis, ie delirium with

  • Meningism
  • Headache and fever[1]

References

  1. ↑ "http://www.bgs.org.uk/Word%20Downloads/delirium.doc". External link in |title= (help)

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