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Query: UMLS:C0009676 (confusion)
 21,692 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Toxic irreversible encephalopathic syndromes developed in 2 patients treated with lithium carbonate and haloperidol. Symptoms consisted of lethargy, fever, tremulousness, confusion, and extrapyramidal and cerebellar dysfunction, accompanied by leucocytosis and elevated serum enzyme, blood urea nitrogen, creatinine and fasting blood glucose levels. One patient suffered widespread irreversible brain damage; the other was left with persistent dyskinesias. Although causal factors have not been identified, this report and others in the literature suggest that diffuse irreversible encephalopathy may occasionally develop in individuals with abnormal brain sensitivity to the lithium carbonate/haloperidol combination. Evidence for this is based on the fact that in our patients and others mentioned in the literature the dosage and blood levels of lithium were not high.
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PMID:Toxic irreversible encephalopathy induced by lithium carbonate and haloperidol. A report of 2 cases. 641 23

Patients with infarctions in the territory of the right middle cerebral artery (RMCA) sometimes present with an agitated confusional state. We reviewed clinical data on 46 patients with RMCA infarcts and compared neurologic findings in patients with and without agitated confusion. Neither of the two patients presenting with agitated confusion showed obvious localizing neurologic signs; subtle motor, visual field and sensory deficits referable to the infarcted regions were present, but difficult to elicit because of the mental state. In contrast, all but one of the patients without agitated confusion had prominent motor and sensory signs. Infarction of the RMCA territory may cause agitated confusion in patients without prominent localizing signs; the initial neurologic findings may suggest a metabolic encephalopathy. However, the possibility of a cerebrovascular cause should not be dismissed in confused and agitated patients who have no definite lateralizing signs.
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PMID:Agitated confusional states in patients with right hemisphere infarctions. 647 40

The D(-) isomer of lactic acid appears to cause a form of metabolic encephalopathy experienced by patients who have had jejunoileal bypass for morbid obesity. However, analysis for D(-)-lactate is not routinely available in clinical or reference laboratories. We describe an enzymic centrifugal-analyzer assay for D(-)-lactate in plasma or serum, with use of D(-)-lactate dehydrogenase. The method involves two-point kinetic calibration and preincubation of specimen and NAD+, thus eliminating the need for specimen-blanking or protein-precipitating pretreatment. This rapid, accurate, and precise assay should be helpful in evaluating patients with "short-bowel syndrome" who display confusion, lethargy, ataxia, or other central nervous-system disturbances that may be ascribable to D(-)-lactic acidosis.
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PMID:Kinetic enzymic assay for D(-)-lactate, with use of a centrifugal analyzer. 661 31

In a series of 1460 consecutive patients admitted to an "acute" stroke unit, 10 patients (0.7%) were found to have a metabolic encephalopathy which mimicked stroke. Of these, three had hypoglycaemia, four had hyperglycaemia, three had hyponatraemia, and one had suffered from hypoxia. Metabolic disorders should be excluded in all patients with a diagnosis of suspected stroke, especially if the presentation is associated with a confusional state or focal seizures. The conventional symptoms and signs of the metabolic disorders may be minimal or absent. The relative rarity of these disorders among patients with suspected stroke is overshadowed by the importance of early recognition and treatment, in order to minimize morbidity and mortality.
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PMID:Metabolic disorders presenting as stroke. 670 May 14

This review of prostaglandins (PGs) covers the following: PGs in obstetrics and gynecology (induction of labor, cervical priming, termination of pregnancies complicated by fetal death, use in 1st and 2nd trimester abortions, and potential contraceptive use); and PGs in other areas of medicine. The original work on the use of PGs in the induction of labor indicated that of the naturally occurring PGs only PGE2 and PGF2alpha are clinically important in reproduction. Ensuing clinical trials confirmed this observation but lead to the conclusion that intravenous PGs for routine labor induction provided no real benefit over intravenous oxytocin, and, in contrast to oxytocin, were associated with frequent gastrointestinal side effects and a pyrexia which could lead to confusion. A recent modification using a cross linked polymer pessary has been designed in an effort to provide a constant sustained release of the incorporated PGE2 for absorption by the vaginal surface. Further studies to assess this innovation are necessary. There was renewed interest in PGs in the mid 1970s when it was observed that they possibly enhanced the outcome of induced labor in patients with an unfavorable cervix. Recent research has established PGE2 as possibly the most efficient cervical priming agent available at this time. A cervical effect may be the reason why PGs are successful in evacuating pregnancies complicated by fetal death. The vaginal route has gained preference as a simple, nontraumatic means of stimulating uterine activity without increasing the chances of intrauterine infection. It seems unlikely that PGs will ever supersede routine aspiration termination of 1st trimester pregnancy. Longterm studies have not been reported yet to indicate that occult cervical damage will be avoided with preoperative PG treatment. Considerable research has been conducted into the safety of PGs for late abortion. Initial concerns of possible coagulopathy, encephalopathy and cardiopulmonary system disturbances have now been largely dismissed; the drugs have been confirmed as safe. The possibility of PGs becoming fertility controlling agents was initially explored in the early 1970s. Although abortion has been successfully induced in 80-90% of treated cases, in many reported series the observed side effects, particularly severe uterine effects, have thus far made the method untenable for routine management. Other uses of PGs include the treatment of spasmodic dysmenorrhea and dysfunctional uterine bleeding and the treatment of gastric ulcers.
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PMID:Prostaglandins. Has the initial promise been realised? 682 14

A 65-year-old woman was rehospitalized for increasing mental confusion 16 days after open heart surgery for mitral stenosis. A diagnosis of transfusion-acquired falciparum malaria was made from a routine peripheral blood smear 24 hours after admission. Because progressive encephalopathy developed while she was receiving antimalarial drugs, a therapeutic exchange transfusion was performed. Clinical improvement occurred promptly during the exchange, and the patient went on to complete recovery from her malaria. The putative blood donor involved met the currently accepted standards for blood donors.
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PMID:Transfusion malaria: treatment with exchange transfusion after delayed diagnosis. 703 44

A neurological syndrome characterized by episodes of confusion, slurred speech, and unsteadiness is described in patients who have undergone jejunoileostomy for obesity. This syndrome has been noted in seven of 110 patients studied, although it may be more common. It appears to subside spontaneously or may respond to oral food restriction, with or without intravenous fluid plus vitamins and minerals. Episodes tend to recur in a given patient. Reversible changes in the EEG have been observed. Pertinent clinical and laboratory findings are described but no definite etiologic factor has been identified. The possible mechanisms involved in this syndrome of metabolic encephalopathy following jejunoileostomy are discussed.
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PMID:Encephalopathy following jejunoileostomy. 725 81

Your recent lead article on toxic shock and tampons (November 1, p. 1161) prompts me to report a case of pelvic infection and staphylococcal septicemia 8 days after the insertion of a Lippes loop. Pelvic infection is a recognized complication of IUDs; although there have been 2 reports of endocarditis occurring in susceptible patients following the insertion of an IUD, septicemia is rare. A previously healthy 31-year old married woman had a loop inserted at a family planning clinic. 3 days later she developed sweating, vomiting, confusion, and cough and during the following 48 hours became disoriented with hallucinations. She was referred to the hospital with suspected encephalitis and on admission was febrile (38.8 degrees Celsius) and stuporose but responded to simple commands. Blood pressure was 95/60 mmHg but there were no other abnormal signs. Hemoglobin was 12.2 g/dl, white blood count 4.0x109/1 (80% neutrophils), erythrocyte sedimentation rate 70mm in the 1st hour; cerebrospinal fluid normal. Chest x-ray examination revealed patchy consolidation in the upper lobes of both lungs and an electroencephalogram showed bilateral nonspecific abnormality. 3 blood cultures taken on admission yielded penicillin-resistant Staphylococcus aureus. She was treated with high-dose intravenous cloxacillin and 24 hours after starting the antibiotic had improved markedly and the IUD was removed. Culture from the coil and also from a high vaginal swab yielded Staph aureus with a similar antibiogram to that of the organism cultured from the blood. Subsequent recovery was uneventful, although repeat chest x-ray examination showed small abscess cavities in the upper lobes of both lungs. The patient was discharged 4 weeks after admission and serial chest radiographs have confirmed complete resolution of the pneumonia and abscesses. There is little doubt that this patients' septicemia with lung abscess formation and encephalopathy originated in the genital tract. The patient was both toxic and shocked but was different from patients with the recently described toxic shock syndrome in that her blood culture was positive for Staph aureus. The case provides another example of the importance of this organism as a cause of infection associated with the insertion of foreign bodies into or through the vagina.
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PMID:Staphylococcal septicaemia after insertion of an intrauterine contraceptive device. 744 49

We report a case of subacute encephalopathy with seizures in chronic alcoholism (age 34 years). This syndrome clearly differs from the known neurological complications of chronic alcoholism. One of the authors has observed (and reported) such cases in the Baltimore area. Subacute encephalopathy is characterized by lethargy, confusion and neurological deficits such as hemiparesis, homonymous hemianopsia and aphasia. Epileptic seizures (generalized tonic-clonic, focal) are obligatory. The EEG shows very prominent slowing and periodic lateralized paroxysmal discharges (PLEDs). The condition is complicated by a variety of internal-medical complications. Structural neuroradiological tests are either normal or irrelevant. The cause and pathogenesis remain obscure. The subacute course ends with gradual resolution.
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PMID:[Subacute encephalopathy with seizures in chronic alcoholism]. 768 29

Bismuth subsalicylate preparations are over-the-counter products for gastrointestinal complaints. Bismuth toxicity causes delirium, psychosis, ataxia, myoclonus, and seizures and is reversible over several weeks or months, when bismuth intake is stopped. We report a 54-year-old man with a 6-week history of progressive confusion and memory difficulty and a 2-3-week history of involuntary movements and gait impairment. His encephalopathy was further characterized by marked multifocal myoclonic jerks, coarse postural tremors, postural instability, and gait ataxia. He gradually improved. Extensive toxic, metabolic, and infectious workup demonstrated bismuth toxicity. Spinal tap and brain magnetic resonance scan were normal. Electroencephalography showed bihemispheric slowing. As his encephalopathy cleared, he reported using bismuth subsalicylate long term (daily intake of 8 oz). Bismuth levels 5 weeks after cessation of bismuth were elevated and normalized after 12 weeks. He followed a typical course for bismuth toxicity with subacute progressive encephalopathy and gradual recovery. Creutzfeldt-Jakob was strongly considered due to his rapidly progressive encephalopathy, multifocal myoclonus, and ataxia. Due to its rarity, bismuth toxicity is often overlooked. We hope this presentation will increase recognition of bismuth toxicity. We believe more detailed labeling of bismuth products is needed to avoid similar toxicity from this readily available product.
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PMID:Bismuth subsalicylate toxicity as a cause of prolonged encephalopathy with myoclonus. 775 66


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