Acute organic brain syndrome

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TO MY MOTHER WHO ENCOURAGE ME TO BE A DOCTOR

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Acute organic brain syndrome

  1. 1. 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 1 DR MAGDI AWAD SASI 2014
  2. 2. 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 2 DR MAGDI AWAD SASI 2014
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  4. 4. 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 4 DR MAGDI AWAD SASI 2014
  5. 5. MANAGEMENT: 1. 2. 3. 4. 5. Quite room Minimum staff changes Constant regimen Repeated reassurance and explanation of medical procedures. Revesible causes to be treated Hypoxia Hypercapnia Vit deficiency Electrolyte disturbance THE MOST EFFECTIVE TREATMENT IS IDENTIFICATION AND ELEMINATION OF THE CAUSE. 5 DR MAGDI AWAD SASI 2014
  6. 6. 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 6 DR MAGDI AWAD SASI 2014
  7. 7. 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 7 DR MAGDI AWAD SASI 2014
  8. 8. 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. 8 DR MAGDI AWAD SASI 2014
  9. 9. 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 9 DR MAGDI AWAD SASI 2014
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