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Confusion implies that while awake a patient exhibits total or partial loss of contact with reality.  If impossible to waken (coma), a diagnosis of confusion may not be made and you should analyze brain function using other signs...

"Confusion/delirium" is not enough to make a diagnosis... you must use other neurological indicators to analyze confused patients...  Please follow the links and then right click back here for a deeper analysis.

  • DEHYDRATION?  Common!!!
  • CEREBRAL TB?  Common!!!
    • Diagnosis: "chronic"; characteristic TB signs of low fever, loss of weight, characteristic TB skin color... sometimes confused; +/- convulsions; patients often have a stiff neck...  See "31-Tuberculosis"
  • HIV DEMENTIA?  Common!!!
    • No fever.  Can be the first manifestation of HIV!  Often begins similar to Alzheimer's or chronic depression (memory loss, loss of concentration...); confusion/delirium; behavioral problems; aphasia; lack of motor coordination; trembling; etc. and sometimes paraplegia!  No curative treatment is available (but often a TOXO treatment test is indicated before making this diagnosis!)  Symptomatic care as for psychological diseases: haloperidol, diazepam…  Death usually comes in weeks or months...
    • See also "19-§1-Symmetrical Neuro Protocol")
  • TOXOPLASMOSIS?  Common!!!  (See also "19-§2-Asymmetrical Neuro Protocol")
    • Diagnosis: Basically, toxo is like one or several tumors in the brain -- the symptoms depend on the position of the tumors.  Alertness can be reduced ("slow brain"); the pronunciation of words can be strange; aphasia can be the only sign; +/- confusion; +/- headache... +/-convulsions; +/-fever,
    • A "Toxo test" is the first thing to do (for a minimum of 5 days!!!): pyrimethamine 25mg 1tab 2x/day (first day 1tab 4x/day) + sulfadiazine 500mg 2-3tabs 4x/day.  If the patient is allergic to sulfa give pyrimethamine 25mg 1tab 2x/day + one of the following drugs: clindamycin 150mg 3-4tabs 4x/day or doxycycline 100mg 1tab 2x/day (only if clinda is not available because it is still not well establish that doxy+pyri is active enough...).
    • If neuro signs improve (stop all pain killers on fifth day to observe the level of pain compared to pre-treatment levels) we should continue the treatment for at least 6 weeks (or forever if possible).
    • Consider that only "pyrimethadine+sulfa" acts very quickly.  For allergic patients, 5 days are not enough for a "toxo test".
    • Consider that toxo is an acute disease that will kill your patient before TB...  If patient is unable to take toxo+TB treatment (can be more than 20 pills!), consider stopping TB treatment during the cure of acute toxo symptoms with the stronger toxo treatment (pyrimethadine+sulfa).  When toxo is under control, give TB treatment + "light" toxo treatment (doxy+pyrimethadine)...
    • See also "19-§2-Asymmetrical Neuro Protocol")
    • Neuro exam is normal.  Treat with haloperidol 5mg 1 to 4tabs 1-2x/day only if patient is suffering or disturbing others.
    • See "27-Psychological Troubles")






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