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Case Files Neurology - part 3

Việc chẩn đoán của mê sảng lâm sàng, với trọng tâm là đánh giá mức độ của sự chú ý. Chú ý có thể được đánh giá bằng cách kiểm tra đảo chiều nối tiếp (chẳng hạn như yêu cầu bệnh nhân để đánh vần một từ về phía sau). Lịch sử bao gồm đánh giá của bệnh nhân có thuốc và các thông tin thu được từ bạn bè hoặc gia đình. | CLINICAL CASES 83 The diagnosis of delirium is clinical with an emphasis on evaluating level of attention. Attention can be evaluated by serial reversal test such as asking the patient to spell a word backwards . The history should include a review of medications patients take and information obtained from friends or family. The neurological examination may not show focal signs or may show myoclonus dysarthria tremor motor abnormalities or asterixis. Laboratory evaluation should include a comprehensive metabolic panel glucose blood urea nitrogen BUN liver function studies electrolyte levels a complete blood count CBC to evaluate for infection thyroid function studies to evaluate for endocrinopa-thy and ammonia to evaluate for hepatic encephalopathy. Arterial blood gas ABG or pulse oximetry should be obtained if the patient has a history of lung disease or smoking. Urine toxicology studies in those individuals with a history of drug abuse or at risk for drug abuse should be requested as well. A CT scan of the head or MRI brain scan needs to be performed with the choice of study depending on ease of obtaining and clinical scenario. Other studies to consider depending on the clinical picture include chest radiograph evaluates for pneumonia electrocardiograph ECG exclude myocardial infarction or arrhythmia electroencephalograph EEG and lumbar puncture if there is concern for central nervous system CNS infection. The differential diagnosis for delirium is extensive see Table 9-3 and includes metabolic causes infections drug-related causes primary neurologic abnormalities trauma and perioperative causes. Importantly delirium must be differentiated from dementia. Typically demented patients have a history of chronic 6 months progression with normal attention except advanced cases and level of consciousness. Perceptual disturbances and fluctuating course are less common with dementia. Table 9-3 SELECTED LISTING OF ETIOLOGIES OF DELIRIUM Etiologies Metabolic disorders .