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Im Board Review

Postoperative delirium in a 64-year-old woman

Matthew Imm, MD, Luis F. Torres, MD and Mohan Kottapally, MD
Cleveland Clinic Journal of Medicine September 2017, 84 (9) 690-698; DOI: https://doi.org/10.3949/ccjm.84a.16102
Gregory W. Rutecki
Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, FL
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Matthew Imm
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  • For correspondence: [email protected]
Luis F. Torres
Department of Neurology, University of Miami Miller School of Medicine, Miami, FL
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Mohan Kottapally
Department of Neurology, University of Miami Miller School of Medicine, Miami, FL
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    FIGURE 1

    Magnetic resonance imaging (sagittal view) without contrast reveals significant frontotemporal atrophy (blue arrows) and deep sulci within the frontal lobe, features not as prevalent in occipital and cerebellar territories (red arrows).

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    TABLE 1

    Common causes of postoperative delirium

    Autoimmune, inflammatoryHematologicPulmonary
    Infection (isolated, sepsis)Hemolytic uremic syndromeHypoxia
    EncephalitisPorphyriaHypercarbia
    MeningitisAnemiaPneumonia
    Cerebral abscessNeurologicRenal
    HyperthermiaSeizureUrinary tract infection
    Hypothyroidism, hyperthyroidismDementiaAcid-base disorder
    CardiovascularStrokeRenal failure
    HypertensionSleep deprivationBladder obstruction
    Myocardial infarctionNeoplasm
    ArrhythmiaTraumatic brain injury
    Shock, hypoperfusionMitochondrial dysfunction
    Electrolyte imbalancePharmacologic causes
    Hypoglycemia, hyperglycemiaPolypharmacy
    HyponatremiaWithdrawal
    DehydrationAlcohol
    HypocalcemiaStimulants, eg, amphetamine
    Hypomagnesemia, hypermagnesemiaSelective serotonin reuptake inhibitors
    Vitamin B12 deficiencyBenzodiazepines
    Thiamine deficiencyCephalosporins (third-generation)
    Gastroenterologic, hepaticDiphenhydramine
    Liver injury, cirrhosisAntidepressants
    P450 alterationBarbiturates
    Fecal impactionAtropine Heavy metals Indomethacin Opiates
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Cleveland Clinic Journal of Medicine: 84 (9)
Cleveland Clinic Journal of Medicine
Vol. 84, Issue 9
1 Sep 2017
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Postoperative delirium in a 64-year-old woman
Matthew Imm, Luis F. Torres, Mohan Kottapally
Cleveland Clinic Journal of Medicine Sep 2017, 84 (9) 690-698; DOI: 10.3949/ccjm.84a.16102

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Postoperative delirium in a 64-year-old woman
Matthew Imm, Luis F. Torres, Mohan Kottapally
Cleveland Clinic Journal of Medicine Sep 2017, 84 (9) 690-698; DOI: 10.3949/ccjm.84a.16102
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    • MEDICAL HISTORY
    • PHYSICAL EXAMINATION
    • INITIAL LABORATORY EVALUATION
    • APPROACH TO ALTERED MENTAL STATUS
    • CASE CONTINUED: ACUTE DETERIORATION
    • CASE CONTINUED: ADDITIONAL SIGNS
    • CASE CONTINUED
    • ALTERED MENTAL STATUS IN INPATIENTS
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