Tony Kadysewski's List: Confusion

• Aortic dissections resulting in rupture have an 80% mortality rate, and 50% of patients die before they even reach the hospital
• About 96% of individuals with aortic dissection present with severe pain that had a sudden onset. It may be described as tearing in nature, or stabbing or sharp in character. 17% of individuals will feel the pain migrate as the dissection extends down the aorta. The location of pain is associated with the location of the dissection. Anterior chest pain is associated with dissections involving the ascending aorta, while interscapular (back) pain is associated with descending aortic dissections.
• Also, individuals suffering from an aortic dissection usually do not present with diaphoresis (profuse sweating).
• Less common symptoms that may be seen in the setting of aortic dissection include congestive heart failure (7%), syncope (9%), cerebrovascular accident (3-6%), ischemic peripheral neuropathy, paraplegia, cardiac arrest, and sudden death. If the individual had a syncopal episode, about half the time it is due to hemorrhage into the pericardium leading to pericardial tamponade.
• Neurologic complications of aortic dissection (i.e., cerebrovascular accident (CVA) and paralysis) are due to involvement of one or more arteries supplying portions of the central nervous system.
• The risk of death due to aortic dissection is highest in the first few hours after the dissection begins, and decreases afterwards. Because of this, the therapeutic strategies differ for treatment of an acute dissection compared to a chronic dissection. An acute dissection is one in which the individual presents within the first two weeks. If the individual has managed to survive this window period, his prognosis is improved. About 66% of all dissections present in the acute phase.
• Individuals who present two weeks after the onset of the dissection are said to have chronic aortic dissections. These individuals have been self-selected as survivors of the acute episode, and can be treated with medical therapy as long as they are stable.
• Medical management is appropriate in individuals with an uncomplicated distal dissection, a stable dissection isolated to the aortic arch, and stable chronic dissections. Patient selection for medical management is very important. Stable individuals who present with an acute distal dissection (typically treated with medical management) still have an 8 percent 30 day mortality.
• The risk of death is highest in the first two years after the acute event, and individuals should be followed closely during this time period. 29% of late deaths following surgery are due to rupture of either the dissecting aneurysm or another aneurysm. In addition, there is a 17% to 25% incidence of new aneurysm formation. This is typically due to dilatation of the residual false lumen. These new aneurysms are more likely to rupture, due to their thinner walls.

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• • Blurred Thinking
   
  • Cloudy Thoughts
   
  • Confused
   
  • Disorientation
   
  • Disoriented
   
  • Fuzzy Thinking
   
  • Inability to Think Clearly
   
  • Inablity to Think Quickly
   
  • Loss of Memory
   
  • Loss of Orientation
   
  • Memory Loss
   
  • Mental Confusion
   
  • Mental Status Change
   
  • Not Thinking Clearly
   
  • Unclear Thinking
    
   
     <!-- TERMS RELATED ENDS -->  <!-- INTRODUCTION --> 

  Confusion is a change in mental status in which a person is not able to think  with his or her usual level of clarity. Frequently, confusion leads to the loss  of ability to recognize people and or places, or tell time and the date. Feelings of  disorientation are common in confusion, and decision-making ability is impaired. 

   

  Confusion may arise suddenly or develop gradually over time. Confusion has  multiple causes, including injuries, medical conditions, medications,  environmental factors, and substance abuse.

• Confusion of a pathological degree, usually refers to loss of orientation (ability to place oneself correctly in the world by time, location, and personal identity) and often memory (ability to correctly recall previous events or learn new material). Confusion as such is not synonymous with inability to focus attention, although severe inability to focus attention can cause, or greatly contribute to, confusion. Together, confusion and inability to focus attention (both of which affect judgment) are the twin symptoms of a loss or lack of normal brain function (mentation).^{[citation needed]} . The milder degrees of confusion as pathological symptoms are relative to previous function. Thus (for example) a mathematician confused about manipulation of simple fractions may be showing pathology which would not be diagnosable in a person without training in this area. Thus, as with the case of delirium, the minor degrees of pathological confusion cannot be diagnosed without knowledge of a person's "baseline," or normal, level of mental functioning.^{[citation needed]}

   

  Confusion may result from a relatively sudden brain dysfunction (see delirium). It may also result from chronic organic brain pathologies such as dementia. In either case, confusion is usually associated with some degree of loss of ability to focus attention, but (as noted) the association is not invariable, especially for lesser degrees of impairment.^{[citation n}
• Confusion is a symptom, and it may range from mild to severe. The confused state may include jumbled or disorganized thought and unusual, bizarre, or aggressive behaviors. A person who is confused may have difficulty solving problems or tasks, especially those known to have been previously easy for the person and an inability to recognize family members or familiar objects, or to give approximate location of family members not present. As well, they may appear to be disoriented, drowsy, or hyperactive. In severe cases, the person may have hallucinations, feelings of paranoia, and a state of delirium.

• a sudden illness, especially when the illness is severe. This is most likely to occur in young children and elderly persons. Even the flu can cause confusion in some people. Other infections, such as the brain infections meningitis and encephalitis, and a serious blood infection called sepsis, commonly cause confusion.
• There are many other causes of confusion. Sometimes, a cause cannot be found.

• People who are confused may exhibit the following signs and symptoms: 

  • They don't know who they are or where they are.
   
  • They don't know what time it is or even what year it is.
   
  • They are drowsy.
   
  • They are not able to concentrate or pay attention.
   
  • They misunderstand the things they see or hear.
   
  • They show poor judgment.
   
  • They have problems with coordination or movement.
   
  • They may be restless or agitated.
   
  • They have trouble remembering recent events.
   

  Other symptoms are often related to the cause of the confusion.
• A confused person should not be left alone. Other monitoring depends on the underlying cause. For example, those who have had a stroke often need close monitoring in an intensive care unit for awhile. Any new or worsening symptoms should be reported to the doctor.

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• Confusion

   

   

    

  Images

   

   

    

   

   Head trauma 

   

   

   

   

   

   

  Confusion is the inability to think with your usual speed or clarity, including feeling disoriented and having difficulty paying attention, remembering, and making decisions.

   

    

  Considerations

   

   

  Confusion may come on quickly or slowly over time, depending on the cause. Many times, confusion is temporary. Other times it is permanent and not curable.

   

  Confusion is more common in the elderly, and often occurs during a hospital stay.

   

  Some confused people may act aggressively.

• Nevertheless, in a minority of cases, it may have an atypical presentation, making the diagnosis clinically challenging. This article reports on a case of acute type A aortic dissection presenting as mental status confusion.

• Symptoms of acute thoracic aortic dissection are often sudden and include severe pain, often described by patients as a very sharp or tearing pain in the chest or in the back between the shoulder blades. The pain may radiate to the shoulder, neck, arm, jaw, abdomen or hips, and the location may change as the aortic dissection progresses. In addition to this sharp pain, patients often suffer from:

   
   
  • Dizziness
   
  • Profuse sweating
   
  • Rapid pulse
   
  • Difficulty walking
   
  • Confusion
   
   

  Sometimes the dissection obstructs branches of the aorta such as the arteries to the legs, resulting in severe leg pain. If an artery to a kidney is blocked, that can result in severe high blood pressure.

• Other symptoms may include:

   
   
  • Changes in thought ability, confusion, disorientation
   
  • Decreased movement, any part of the body
   
  •  Decreased sensation, any part of the body
   
  •  Dizziness 
   
  •  Dry mouth 
   
  •  Dry skin 
   
  •  Fainting 
   
  • Intense anxiety, anguish
   
  •  Nausea and vomiting 
   
  •  Pallor 
   
  •  Profuse sweating (clammy skin)
   
  •  Rapid, weak pulse 
   
  •  Shortness of breath -- difficulty breathing when lying flat (orthopnea)
   
  •  Thirst
• Drugs that lower blood pressure may be prescribed. These drugs may be given through a vein (intravenously). Strong pain relievers are usually needed. Heart medications such as beta-blockers may reduce some of the symptoms.
• Many cases of aortic dissection cannot be prevented.

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