DR Medhat MRCP

Acute Confusional State
- Is also known as delirium or acute organic brain syndrome.
- It`s a reversible impairment of cognitive functions.
- It affects up to 30% of elderly patients admitted to hospital.
• Causes : (HIDE MAP)
1. H: hypoxia
2. I : infection
3. D: drugs
4. E: endocrine, e.g. diabetes
5. M: metabolic, e.g. hyper/hypocalcaemia
6. A: alcohol
7. P: psychosis
• Features : wide variety of presentations
1. Memory disturbances (loss of short term > long term).
2. May be very agitated(hyperactive) or withdrawn(hypoactive).
3. Disorientation.
4. Mood change. Often worse at night.
5. Visual hallucinations.
6. Disturbed sleep cycle
7. Poor attention
• Management
1. Treatment of underlying cause.
2. Modification of environment.
سؤال هام lorazepam. 3. Haloperidol 0.5 mg as 1st line x 1 week ( RCP guidelines) then
Wernicke's encephalopathy
- Is a neuropsychiatric disorder caused by thiamine deficiency which is most
commonly seen in alcoholics.
- Rarer causes include: persistent vomiting, stomach cancer, dietary deficiency.
- In Wernicke's encephalopathy petechial haemorrhages occur in a variety of
structures in the brain including the mamillary bodies and ventricle walls
Features :
1. Nystagmus
2. Ophthalmoplegia Classical triad.
3. Ataxia
4. Confusion, altered GCS
5. Peripheral sensory neuropathy
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