Acute Confusion: Neurological Causes

• Epilepsy, post-ictal confusion. Neurocysticercosis is a major cause of epilepsy in large parts of Central and South America.

• Cerebrovascular accident due to thrombosis or cerebral embolism (increased risk in Chagas’ disease, endocarditis, sickle cell crisis).

• Loasis (Loa loa infection) with high microfilariaemia can cause acute neurological symptoms, often just after commencement of therapy.

• Hypertensive encephalopathy is usually clinically manifest. It is a medical emergency. Blood pressure is very high and the eye fundus is typical.

• Inflammation of the brain and/or meninges . Cerebral vasculitis can occur in a systemic disease such as systemic lupus erythematosus. Immunosuppression in SLE-patients, e.g. by therapy with steroids, increases the risk of some complications, such as tuberculosis, including meningeal tuberculosis (not infrequent in India). Beware of Strongyloides hyperinfection when people use corticosteroids.

• Head injury, with concussion or subdural haematoma.

Category: Neurology notes , Psychiatry Notes