1/5. Non-convulsive status epilepticus with marked neuropsychiatric manifestations and MRI changes after treatment of hypercalcaemia.We describe a 77-year-old woman who developed a confusional state, cognitive impairment, behavioural abnormalities and dysphasia after treatment of hypercalcaemia. Repeated EEG recording revealed rhythmic sharp-wave activity over the right parietal-occipital lobe. magnetic resonance imaging (MRI) showed marked hyperintense signal changes bilaterally. The diagnosis of a non-convulsive status epilepticus (NCSE) was made. With antiepileptic treatment the patient improved and MRI as well as EEG changes were almost all reversible. NCSE is an important differential diagnosis of patients with neuropsychiatric symptoms and can develop after rapid lowering of serum calcium levels in hypercalcaemia.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
2/5. Tuberculous meningitis masked by delirium in an alcohol-dependent patient: a case report.OBJECTIVE: patients with alcohol dependence syndrome can present with delirium which will mask underlying organic causes for the delirium. However, other medical diseases can also present with similar symptoms and should not be missed. The issues related to differentiating the different causes of delirium are briefly discussed. We describe a case of tuberculous meningitis in a patient with history of alcohol dependence who presented with delirium. METHOD: A case report. RESULTS: A 38-year-old male was admitted with history of irrelevant talk and abnormal behaviour of 2-month duration. He was also disoriented and his short-term memory was impaired. He reported visual hallucinations. He had history of alcohol dependence of 5 years. A detailed mental status examination and neurological workup revealed an organic psychosis. CT scan showed a hypodense lesion suggestive of a tuberculoma. The cerebrospinal fluid findings were corroborative. He responded to antituberculous drugs which he took for one and a half years and recovered completely. He also underwent group therapy for his alcohol dependence and has since then refrained from alcohol intake. Currently he has gone back to his work as a car mechanic. CONCLUSION: We have highlighted the need for diagnosing and investigating carefully the cause of delirium in a patient with alcohol dependence syndrome. This shows that other curable causes of delirium must also be investigated in patients with alcohol dependence.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
3/5. patients' dreams in ICU: recall at two years post discharge and comparison to delirium status during ICU admission. A multicentre cohort study.Discharged intensive care unit (ICU) patients often recall experience vivid dreams, hallucinations or delusions. These may be persecutory in nature and are sometimes very frightening. It is possible that these memories stem from times when the patient was experiencing delirium, a common syndrome in the critically ill. Routine screening for delirium in ICU is becoming more prevalent, however, little has been published comparing the objective development of delirium (patient observations using screening tools) and patients' subjective recollection of dreams and unreal experiences in the ICU. This study describes the relationship between observed behaviour during ICU admission and the subjective memories of ICU experiences amongst 41 participants in three ICUs up to 24 months post discharge. overall, 44% of patients (n=18) recalled dreams during their ICU admission. There was a trend to increased prevalence of dreaming (50% versus 39%) amongst the 18 patients who were delirious during their ICU admission than in the 23 non-delirious patients. Dreaming was significantly associated on logistic regression with increased length of stay (OR 1.39, 95% CI 1.08-1.79, p=0.01), but not delirium status (OR 1.56, 95% CI 0.45-5.41, p=0.49). A longer ICU stay was significantly associated with the experience of ICU dreaming. As many dreams are disturbing, we suggest providing information and counselling about delirium to patients who remain in ICU for longer periods.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
4/5. pellagra: unusual cause of paranoid delirium in dialysis.A 60-year-old woman treated by maintenance haemodialysis refused to take part of the usual vitamin supplements for many years. After an intercurrent illness with profound malnutrition, she developed a paranoid delirium and some behavioural disorders; concomitant diarrhoea and a skin rash were noted. Parenteral nicotinamide (500 mg/day) resulted in a complete recovery from the mental disorders after five days. Other causes of mental disturbance as a result of dialysis could be ruled out. However an asymptomatic underlying hypothyroidism may have been one of the conditioning factors as well as the failure to administer nicotinamide supplements during an acute illness. Neurological pellagra could thus be considered as a rare but reversible cause of mental disorders in patients on maintenance haemodialysis.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
5/5. Manic delirium and frontal-like syndrome with paramedian infarction of the right thalamus.A disinhibition syndrome affecting speech (with logorrhoea, delirium, jokes, laughs, inappropriate comments, extraordinary confabulations), was the main manifestation of a right-sided thalamic infarct involving the dorsomedian nucleus, intralaminar nuclei and medial part of the ventral lateral nucleus. Resolution of conflicting tasks was severely impaired, suggesting frontal lobe dysfunction. These abnormalities correlated with the finding on SPECT of a marked hypoperfusion in the overlying hemisphere predominating in the frontal region. We suggest that this behavioural syndrome was produced by disconnecting the dorsomedian nucleus from the frontal lobe and limbic system.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |