Fleeting hallucinations that arouse restlessness, fear, and even terror are common. Autonomic lability, evidenced by diaphoresis and increased pulse rate and temperature, accompanies the delirium and progresses with it. The patient is suggestible to many sensory stimuli, particularly to objects seen in dim light. Vestibular disturbances may cause him to believe that the floor is moving, the walls are falling, or the room is rotating. As the delirium progresses, a persistent coarse resting tremor of the hand develops, sometimes extending to the head and trunk.
Symptoms vary among patients but are usually the same for a particular patient with each recurrence.
Appreciably elevated temperature in delirium tremens is a poor prognostic sign. Although delirium tremens may be fatal, the course is usually self-limited, terminating in a long sleep. Delirium tremens should begin to resolve within 12 to 24 h, and if improvement is not marked within this interval, other disorders, such as subdural hematoma, a hepatic or renal disorder, or other mental disturbances, should be suspected. Its pathologic and clinical features are probably identical to the cerebellar involvement of Wernicke's encephalopathy. Ataxia of stance and gait evolves over weeks or months but can appear acutely.