Delirium post-stroke

Abstract

Delirium is not only one of the most common complications that older patients develop after admission to hospital but it is also one of the most serious. Although stroke is a known predisposing factor for delirium, few studies have investigated this association and results from existing studies give conflicting results with prevalence estimates ranging from 13 to 48%. The aetiology of delirium post-stroke is poorly understood. There is no consensus on the best screening tool to use to detect delirium in the post-stroke setting. Specific stroke types may be more likely to precipitate delirium than others, for example, delirium is more frequent after intracerebral haemorrhage and total anterior circulation infarction (TACI). In addition, case reports have suggested that delirium may be associated with specific lesions, for example, in the thalamus and caudate nucleus. There is a lack of intervention data in both the prevention and treatment of delirium post-stroke. However, it is known that the development of delirium post-stroke has grave prognostic implications. It is associated with longer stay in hospital, increased mortality and increased risk of institutionalisation post discharge. In this article, we review the literature to date on delirium in the acute stroke setting.

Rehabilitation of Cardiovascular Disorders and Sleep Apnea

“…102,103 This delirium can prolong hospital stay and increases risk of dementia and admission to an institution. 103,104 Well-known risk factors for delirium are hypoxemia 105 and OSA, which can be reversed by CPAP treatment. [106][107][108] These studies show high prevalence of OSA at different time points from stroke onset or cardiac event and OSA exerts a negative effect on the functional recovery of these patients.…”

Risk Factors for Delirium in the Acute Stroke

“…The pathogenesis of delirium in general remains unknown (White S, 2002). There are several possible mechanisms for the development of delirium ( (McManus et al, 2007) It is known that delirium is associated with generalised slowing on electroencephalogram (EEG) that is consistent with widespread cortical dysfunction, which presumably accounts for the wide range of symptoms that delirious patients present with.…”

“…Table 5. Main predisposing factors for development of delirium, (McManus et al, 2007) Certain types of stroke are more associated with the onset of delirium and complications after a stroke can accelerate the development of delirium. In essence, it is highly likely that the greater stroke cause delirium, but in such patients is increasing and likely to develop medical complications, which in itself can cause delirium.…”

“…Due to the specific problems and the complexity of diagnosis and therapy, there are specialized units for care of these patients (Wahlund, Gonzalez, 1999 Table 6. Summary of prospective studies that have assessed post-stroke delirium, (McManus et al, 2007) delirium in these classes about 40% had dementia, 30% mild cognitive deficit, and 14% depression. It should be keep in mind that the large number of cases of dementia and delirium requires etiological clarification.…”

Paciente con alteración de conciencia en urgencias

“…Tienen especial riesgo de presentar un síndrome confusional las personas de edad, a veces por simple deshidratación, los pacientes con daño cerebral vascular o degenerativo, especialmente si han de ser hospitalizados y aún más si van a ser sometidos a anestesia general y los pacientes en tratamiento con benzodiacepinas y anticolinérgicos 10 . Debe excluirse siempre la posibilidad de una privación alcohólica.…”