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
- 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
- TOXOPLASMOSIS? Common!!!
(See also "19-§2-Asymmetrical Neuro
- 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;
- 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
- 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
- Can also be stroke, lymphoma, syphilis,
hepatic failure, etc. (as for HIV negative