Source: https://www.stylite.net/sida-aids/protocol19-neuro-en-confusion.htm
Timestamp: 2020-06-07 01:55:18
Document Index: 598783539

Matched Legal Cases: ['§4', '§1', '§2', '§2', '§3', '§2', '§1']

aids-hospice-mouroir-sida-medical-protocol-neurology-en
19-§4-Confusion/delirium
Confusion implies that while awake a patient exhibits total or partial loss of contact with reality. If impossible to waken (coma), a diagnosis of confusion may not be made and you should analyze brain function using other signs...
"Confusion/delirium" is not enough to make a diagnosis... you must use other neurological indicators to analyze confused patients... Please follow the links and then right click back here for a deeper analysis.
DEHYDRATION? Common!!!
Dehydration alone can cause confusion!!! See "8-Dehydration"
CEREBRAL TB? Common!!!
Diagnosis: "chronic"; characteristic TB signs of low fever, loss of weight, characteristic TB skin color... sometimes confused; +/- convulsions; patients often have a stiff neck... See "31-Tuberculosis"
HIV DEMENTIA? Common!!!
No fever. Can be the first manifestation of HIV! Often begins similar to Alzheimer's or chronic depression (memory loss, loss of concentration...); confusion/delirium; behavioral problems; aphasia; lack of motor coordination; trembling; etc. and sometimes paraplegia! No curative treatment is available (but often a TOXO treatment test is indicated before making this diagnosis!) Symptomatic care as for psychological diseases: haloperidol, diazepam… Death usually comes in weeks or months...
See also "19-§1-Symmetrical Neuro Protocol")
TOXOPLASMOSIS? Common!!! (See also "19-§2-Asymmetrical Neuro Protocol")
Diagnosis: Basically, toxo is like one or several tumors in the brain -- the symptoms depend on the position of the tumors. Alertness can be reduced ("slow brain"); the pronunciation of words can be strange; aphasia can be the only sign; +/- confusion; +/- headache... +/-convulsions; +/-fever,
A "Toxo test" is the first thing to do (for a minimum of 5 days!!!): pyrimethamine 25mg 1tab 2x/day (first day 1tab 4x/day) + sulfadiazine 500mg 2-3tabs 4x/day. If the patient is allergic to sulfa give pyrimethamine 25mg 1tab 2x/day + one of the following drugs: clindamycin 150mg 3-4tabs 4x/day or doxycycline 100mg 1tab 2x/day (only if clinda is not available because it is still not well establish that doxy+pyri is active enough...).
If neuro signs improve (stop all pain killers on fifth day to observe the level of pain compared to pre-treatment levels) we should continue the treatment for at least 6 weeks (or forever if possible).
Consider that only "pyrimethadine+sulfa" acts very quickly. For allergic patients, 5 days are not enough for a "toxo test".
Consider that toxo is an acute disease that will kill your patient before TB... If patient is unable to take toxo+TB treatment (can be more than 20 pills!), consider stopping TB treatment during the cure of acute toxo symptoms with the stronger toxo treatment (pyrimethadine+sulfa). When toxo is under control, give TB treatment + "light" toxo treatment (doxy+pyrimethadine)...
See also "19-§2-Asymmetrical Neuro Protocol")
Neuro exam is normal. Treat with haloperidol 5mg 1 to 4tabs 1-2x/day only if patient is suffering or disturbing others.
See "27-Psychological Troubles")
Can also be stroke, lymphoma, syphilis, hepatic failure, etc. (as for HIV negative patient)
See "19-§3-Paralysis Protocol","19-§2-Asymmetrical Neuro Protocol", "19-§1-Symmetrical Neuro Protocol"...