Delirium

Antimicrobial neurotoxicity: an under-recognised cause of delirium

Case Reports, Volume 21, Issue 2, Pages 65-120 (2022)

Antimicrobial associated encephalopathy (AAE) is a well-documented, though under recognised, adverse event associated with antimicrobial use.1 Clinical manifestations of AAE are varied, ranging from myoclonus and seizure to an encephalopathy with cerebellar signs.1 The phenotypic presentation of the encephalopathy syndrome is, in general, governed by the antimicrobial in question. Given its apparent rarity in everyday clinical practice, awareness of AAE is crucial for physicians. We describe a reversible encephalopathy characterised by confusion, myoclonus and stupor in a 76 year old gentleman on antimicrobial therapy for a peri-rectal abscess.

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Period-Prevalence and Risk Factors for Delirium in a Tertiary Referral ICU: A prospective cohort study

Original Articles, Volume 20, Issue 3, Pages 157-248 (2021)

Background: Delirium is common in intensive care and leads to increases in morbidity, mortality, Intensive Care Unit (ICU) length of stay, and hospital length of stay. Certain risk factors predict the appearance of delirium.
Study Objectives: To determine the rates of delirium, the rate of risk factors, and their relationship to the occurrence of delirium in an adult ICU.
Methods: Single-centre, prospective, observational study. Demographic and treatment data were collected. The Confusion Assessment Method for ICU (CAM-ICU) was performed twice daily to assess for delirium continuously during a 3-week period. Statistical analysis was used to determine the relationship between risk factors and the occurrence of delirium.
Results: 86 patients were screened, 44 patients were included, and 260 patient-days were analyzed. The incidence of delirium was 42.9%, the prevalence of delirium in ICU was 50%. Urinary catheters and use of opioids were the most common factors with a positive association for occurrence of delirium. Exposure to daylight and sleeping for more than 4 hours at night were the factors most commonly associated with a lack of delirium.
Conclusion: The rates of delirium in ICU were high and risk factors occurred frequently. Addressing modifiable risk factors, including the promotion of adequate sleep, could improve outcomes.

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Fever, delirium and incontinence: not always a UTI

Case Reports, Volume 15, Issue 3, Pages 109 – 164 (2016)

Abstract

Unexplained fever and confusion is a common reason for emergency medical admission. When this occurs in the context of new urinary incontinence, a urinary tract infection may be considered to be the most likely cause. However it is also important to consider spinal pathology when this combination of symptoms arises. We present a case of a retropharygeal collection presenting in a patient with this combination of symptoms.

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Non-Convulsive Status Epilepticus as a cause for prolonged delirium: an under-diagnosed phenomenon?

Case Reports, Volume 11, Issue 4, Pages 193 - 264 (2012)

Abstract

Delirium is a common cause for acute hospital admissions. There are many potential causes for this presentation, including infection, polypharmacy and metabolic disorders. We present the case of a patient with hyponatraemia and prolonged delirium, in whom the diagnosis of non-convulsive status epilepticus (NCSE) was made following electroencephalography (EEG).

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Delirium (acute toxic confusion) in the elderly

Clinical Reviews, Volume 2, Issue 1, Pages 1 - 36 (2003)

Abstract

Delirium (also referred to as acute confusional state or toxic confusional state) is common in elderly patients admitted to hospital, and is usually secondary to an acute physical problem rather than being a primary abnormality. Physicians caring for acutely ill patients will frequently encounter those with delirium and need to be aware of the likely precipitants as well as the optimum management. We discuss the common precipitants, the clinical features, the differential diagnosis and the management of delirium.

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