Cystocerebral Syndrome: An Updated Review and a New Proposed Mechanism for an Often Forgotten Cause of Delirium

Abstract

Cystocerebral syndrome is an often forgotten cause of delirium in elderly males, which is quite easily treated. We reviewed the current body of literature documenting cystocerebral syndrome and proposed a new mechanism of action explaining why all patients identified thus far have been male. Data was obtained from articles describing cases of cystocerebral syndrome, urinary retention, and confusion in addition to delirium via a PubMed database search. We reviewed all articles describing cases of cystocerebral syndrome via the PubMed database using the Medical Subject Headings (MeSH) keywords of "cystocerebral syndrome,” urinary retention and confusion," and "delirium and urinary retention or cystocerebral syndrome," and identified eight cases of cystocerebral syndrome including the original publication by Blackburn and Dunn. We found that all patients reported in the literature were males older than 70 years and often with concomitant benign prostatic hypertrophy (BPH) who presented with acute episodes of delirium that rapidly responded to bladder decompression. The authors seek to update the medical community regarding this uncommon phenomenon of delirium in elderly male patients. We also propose that the lack of female patients in the literature is reflective of their decreased intraurethral flow resistance as is currently being described in other avenues of research in the field of urodynamics.

Acute Delirium Post-inguinal Hernia Mesh Repair in a 40-Year-Old Male: An Unusual Case of Cystocerebral Syndrome

“…Cystocerebral syndrome is a term used to describe a state of encephalopathy or delirium characterized by symptoms such as agitation, paranoia, confusion, reduced responsiveness, and difficulty with redirection which typically occurs in the presence of bladder distention [ 2 ]. The syndrome has been classically described in male patients older than 70 years who often had a history of benign prostatic hypertrophy (BPH) [ 12 ]. Blackburn and Dunn in 1990 proposed the concept of cystocerebral syndrome, where acute urinary retention in elderly patients could present as sudden confusion or delirium [ 2 ].…”

“…A comprehensive evaluation of patients is recommended in patients with suspected cystocerebral syndrome which includes reviewing the patient’s medical history, evaluating for conditions such as BPH, diabetes mellitus, and constipation, as well as performing necessary physical examinations [ 12 ]. Treatment is usually done with immediate bladder decompression and medical management with alpha-adrenergic receptor antagonists such as tamsulosin [ 12 ]. Hence, bladder distention is central to the mechanism of cystocerebral syndrome.…”

Síndrome cistocerebral: a propósito de un caso

“…Además, se ha observado que algunos pacientes, a pesar de esta activación simpática, presentan hipotensión arterial y bradicardia. Esta respuesta paradójica podría explicarse con los trabajos de Lee y col., quienes observaron que la distensión mantenida de la vejiga urinaria en pacientes con hiperlipidemia se relaciona con vasoconstricción epicárdica e incremento de las resistencias coronarias (7,8). Esto disminuiría la contractilidad y la fracción de eyección cardiaca, con una reducción de la frecuencia cardiaca, de la tensión arterial media y del gasto cardiaco, que podría ocasionar secundariamente una reducción de la perfusión cerebral y un enlentecimiento de la actividad eléctrica cortical vista en el EEG (9).…”

Cystocerebral Syndrome in a Patient with Altered Mental Status

“…Cystocerebral syndrome is a term used to describe delirium in elderly patients that is caused by acute urinary retention [ 1 ]. This syndrome can include symptoms of agitation, confusion, paranoia, decreased responsiveness, and increased difficulty in redirecting the patient [ 2 ]. In 1990, Blackburn and Dunn were the first to describe acute urinary retention presenting as delirium in elderly men [ 3 ].…”