ACUTE ORGANIC BRAIN SYNDROME:

Are abnormal mental status that begins abruptly , run a course ranging from a few days to 3—4 weeks.

It is associated with intrinsic brain disease with central dysfunction secondary to extra—cerebral physical disease and intoxication.

THE SYNDROMS:

Delirium---- acute brain syndrome Acute confusional state Exogenous psychosis Toxic psychosis Metabolic encephalopathy

Dysmnesic syndrome-----Amnestic syndrome

Wernicke—korsakow syndrome

Quasin functional syndromes

Organic affective syndrome Organic delusional syndrome Organic hallucinosis

DELIRIUM

Most frequent and important syndrome

C/F:

Principal feature---reduction in level of conscious awareness((clouding)).

It is manifested clinically as disorientation in time/space, worse at night.

Other psychological symptoms:

Poorly sustained attention Memory impairment Liability of mood Disordered thought and speech Paranoid misinterpretion Visual and auditory hallucination

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Physical symptoms:

Restlessness , Tremor ,Ataxia ,Slurred speech ,Incontinance.

Behavior disturbance – wandering ,aggressive outbursts

Predisposing factors:

Age—any age- common in young children and elderly pts( dementia).

Environments – sensory and social isolation.

Drugs and alcohol abuse – predispose to delirium more readily

Pathophysiology:

The cerebral dysfunction lie in brain stem reticular formation , thalamic nuclei mainly mid line. This leads to disturbance in arousal ,attention ,wake sleep cycle.

Diagnosis:

EEG--- slowing of alpharhythm (( 8—13)) cycles/ second

Emergence of theta (( 4 ---7 )) cycles /second

Bilateral symmetrical predominant frontal delta waves (( 3)) cycles/s

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CAUSES OF DELIRIUM:

1--Intoxiction—drugs , alcohol ,organic solvents ,glue , fuels, industial toxins ,CO

Poisonous plants and fungi

2--Metabolic – Hypoxia

Hypoglycemia

Electrolyte disturbance

Renal / Hepatic failure

Vit Deficiency (( A/ D))

Endocrine disorders

Porphyria

3--Infections systemic , intracranial

4--Physical injury cranial trauma

Heat stroke

Hypothermia

Radiation

5--Vascular and cardiovascular disorder

Cerebral infarction

HTN encephalopathy

Subarachnoid haemorrhage

Cardiac failure/Arrest/ atrial fibrillation

Collagen vascular disease

6--Intracranial space occupying lesion

Hematoma /Abscess / Tumor

7--Epilepsy

8--Withdrawal syndrome -- Benzodiazepines /Barbiturates /Alcohol/ Chlormethiazole

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MANAGEMENT:

1. Quite room2. Minimum staff changes3. Constant regimen4. Repeated reassurance and explanation of medical procedures.5. Revesible causes to be treated Hypoxia Hypercapnia Vit deficiency Electrolyte disturbance

THE MOST EFFECTIVE TREATMENT IS IDENTIFICATION AND ELEMINATION OF THE CAUSE.

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DRUGS USED IN TREAMENT:

Need of treatment –restlessness

Wandering

Combativness

Behavioral disturbance

Drug therapy-- symptomatic

1.Should be flexible

2.Dosage according to the age and severity of disturbance.

3.Timing ideal with nocturnal variation in behavior

Tranquilizer are effective.

Haloperidol oral I/M I/V

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0.5mg ---10mg /2 - 3 times

Crisis ---5 -10mg I/V highly effective , can be repeated ½ hourly

Phenothiazine---promazine ,chloropromazine,thioridazine

Affective in controlling agitation ,aggression , noisy, restlessness.

Oral or I/M --- 25mg elderly , 500mg young

Benzodiazepines--- diazepam

Effective in alcohol / drug withdrawal delirium

Disadvantage—excessive sedation and increased confusion in elderly

40—80 mg Diazepam daily orally or intravenously.

Chlormethiazole—

Short acting sedation and anticonvalsant with hypnotic properties.

Useful in 1.Alcohlo withdrawal 2. Drug withdrawal

Dose 1—1.5 mg daily orally

1 hour a day of 0.8% I/V

Risk of dependence

Prognosis:

Depends on causative condition

Commonest out come—complete recovery

MR 12%

DRUGS CAUSING DELIRIUM:

Tranqulizer and hypnotics—Barbsiturate,Benzodiazepine,Bromide,Neuroleptics.

CVS drugs---- Digoxin , B blocker , Diuretic

Anticholinergic – Hyoscine, TCA, Antiparkinson,Atropine ,Homatropine

Dopamine agonist—Levodopa, Bromocriptine ,Amantidine

Antituberculosis—INH , Cycloserine , Rifampicine

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Antibiotics---Peniciline ,Streptomycine ,Sulphonamide

Anticonvulsants – Phenytoin , NA valporate

Others –Chloroquine , Hypoglycemic, Piperzine, Disulfiram

Drug withdrawal –Alcohol, Barbiturates ,BZA.

DYSMNESTIC SYNDROME: “ Korsakows syndrome”

C/F:

Characterized by defective retention of memory of new information.

Retention span being less than one minutes with relative sparing of remote memory and intellectual function.

Classically; the memory hiatus is filled by fanfasy memories “ confabulation”

CAUSES:

A.Thiamine deficiency---- alcoholism , hyperemesis gravidarum

B.Wernickes encephalopathy in thiamine deficiency

Alcohol , Vomiting(( upper GIT obstruction , starvation ,anorexia nervosa,hunger shiker)

C/F:

Impairment of consciousness.

Progressing to coma

Ocular and conjugate gaze paralysis

Nystagmus

Truncal ataxia

C.Head injury

D.Encephlitis involving both temporal lobes

PATHOLOGY:

Small puntate haemorrhage in the region of mamary bodies.

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In wernichs ,all the region of III ventricle of brain.

Treatment:

Thiamine 20—100mg daily for a week then contined orally over several wks

Treat the underlaying cause.

QUASIN FUNCTIONAL SYNDROMES:

1.Organic affective syndrome—

Major depression or mania---- drug ingestion // physical illness

2.Organic delusional syndrome—

Schizophrenia // schizo-affection psychosis with delusion , hallucination ,bizarre behavior and though disorders.

3.Organic hallucinosis---

Usually visual in colour

Drugs --- TCA , Antiparkinson , Digoxin ,B blocker ,Pentazocine

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