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Delirium in a 74-year-old man : correct imaging revealed the truth

Dr- Wani delirium in 74 yr old. Delirium in a 74-year-old man : correct imaging revealed the truth. acute onset and fluctuating symptoms disturbance of consciousness (including inattention )

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Delirium in a 74-year-old man : correct imaging revealed the truth

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  1. Dr- Wani delirium in 74 yr old Delirium in a 74-year-old man: correct imaging revealed the truth

  2. acuteonset and fluctuatingsymptoms • disturbanceof consciousness (including inattention) • at least one of thefollowing: • Disorganisedthinking, • Disorientation, • Memory impairmentor perceptual disturbance • Evidence of a putative causalmedical condition OVERVIEW What is delirium ? DSM-IV criteria

  3. OVERVIEW FIGURE 156-3 Diagnosis of delirium according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). CDNOS, cognitive disorder not otherwise specified. Walsh: Palliative Medicine 1st ed

  4. OVERVIEW “The Scream” by Edvard Munch (1893).

  5. Physical examination: • A 74-year-old man with known hypertension and benign prostatichyperplasia • presented with a 1-week history of fever. • The patientreceived amoxicillin and paracetamol • Four days later the patient became confusedand refused to take the treatment orally. • confused, disoriented and hypoactive. • Pulse rate was 102 bpm, temperature 37.9°C and blood pressurewas 150/70 mmHg. • The rest of the examination was unremarkable • there was no focal neurological deficit CASE PRESENTATION History :

  6. CASE PRESENTATION • WBC 4.1/mm3 • urine analysis : 6–12 puscells per HPF • ESR :45 mm in the first hour. • Serum electrolytes ,renal and liver functions : normal • CT scan brain : normal. Investigations :

  7. As treatment of UTI CASE PRESENTATION ? Hospital Course :

  8. Protein = 0.9 g/l • total cell count = 45 (90% lymphocytes). • Cultures, latex and acid-fast bacillus stainingwere negative in the CSF. CASE PRESENTATION CSF Finding • Polymerase chain reaction for denguewas negative and the patient’s condition deteriorated. • Work-up forunderlying malignancy was inconclusive. 

  9. CASE PRESENTATION Imaging :

  10. OVERVIEW More imaging :

  11. Sepsis-induced delirium, dengue meningo-encephalitis, toxoplasmosisand neurocysticercosis. OVERVIEW Treatment Antibiotics, anti-tubercular medication and dexamethasone. Differential Diagnosis Out come Improved and is on regular follow-up.

  12. DISCUSSION predisposing factors for delirium in elderly

  13. DISCUSSION precipitating factors for delirium in elderly

  14. DISCUSSION Some studies show :

  15. DISCUSSION evealedvariable results Only 14% of the cases had pathological lesions Imaging of the brain in acute confusion :

  16. DISCUSSION CNS Tuberculosis :

  17. Elderly patients with delirium and sepsis need open-mindedapproach . • Brain imaging, especially MRI, may revealunusual and potentially reversible lesions and must be considered. Conclusion Conclusion:

  18. underlyingserious illness can present with delirium Learning points Imaging for the brain must be selected oncase by case basis. Tuberculomasmay involve any part of the brain tissue without focal neurologicaldeficits.

  19. Dr- Wani delirium in 74 yr old Thank You Done by : Dr. AbdulmajedWani

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