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What Causes Disorientation And Confusion State In A Person With History Of Stroke?
Posted on
Sun, 16 Aug 2015
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Sun, 16 Aug 2015
Answered on
Wed, 2 Sep 2015
Last reviewed on
Question : My brother who is 63 years old was just admitted to a hospital because he was found in a store completely disoriented, didn't know who he was or where. He was taken to emergency. He eventually remembered who he is but is very disoriented still. Last night he insisted on leaving and tried to hit 2 people. They have him in restraints now as he insists on leaving the hospital. The found evidence of 1 or two past XXXXXXX strokes but nothing new. His blood pressure is now stable but it was very high when he came in. The hospital he is in is in a small town and he wants to be moved the university hospital in XXXXXXX MO. near where he is. The hopital he is at cannot find the problem. Should he be moved? Any thoughts on what might be causing this. Apparently he has been having a few previous episodes that we didn't know about but his friends didn't tell us. My brother has always been estranged from the family and we know very little about him. Thanks for any ideas or suggestions you might have.
Brief Answer:
Cause can be many
Detailed Answer:
I read you question and I understand your concern.
The causes of his confusional state can be several. In the setting of the history for stroke one possibility might be partial seizures to which post stroke patients can be prone. Also transitory lack of blood supply due to heart or neck vessels issue may cause brain suffering.
Another directly brain related cause may be a neurological infection which is not always visible on imaging (especially if only CT), a lumbar puncture may be necessary.
Given the lack of information on his lifetyle use of drugs or alcohol are another possible cause.
Another cause may be metabolic changes, alterations in blood glucose, liver and kidney function, electrolytes, nutritional deficiencies like vitamin b1, b12 deficiency. Some of those though I suppose have been excluded by the hospital.
So it is difficult to determine the cause without more info. Regarding the transfer though I believe that can be done. Since the current hospital can't offer an explanation perhaps a bigger center might have more tests in its disposal and more expertise to identify and treat the cause.
I remain at your disposal for further questions.
Cause can be many
Detailed Answer:
I read you question and I understand your concern.
The causes of his confusional state can be several. In the setting of the history for stroke one possibility might be partial seizures to which post stroke patients can be prone. Also transitory lack of blood supply due to heart or neck vessels issue may cause brain suffering.
Another directly brain related cause may be a neurological infection which is not always visible on imaging (especially if only CT), a lumbar puncture may be necessary.
Given the lack of information on his lifetyle use of drugs or alcohol are another possible cause.
Another cause may be metabolic changes, alterations in blood glucose, liver and kidney function, electrolytes, nutritional deficiencies like vitamin b1, b12 deficiency. Some of those though I suppose have been excluded by the hospital.
So it is difficult to determine the cause without more info. Regarding the transfer though I believe that can be done. Since the current hospital can't offer an explanation perhaps a bigger center might have more tests in its disposal and more expertise to identify and treat the cause.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
There was a lot of alcohol & drug use in the past but not much in the last few years. He is on a heart medication & blood pressure med. his doctor recently put him on a med called rapaflow? ( not sure of the spelling) but he thought it was not agreeing with him so he stopped taking it. But he began taking it again in the last couple of days. That's all the info I could get from him. I'm calling all the pharmacies in his town but it's Sunday and many are closed. No luck yet. Our father had some sort of dementia before he died, he lost long & short term memory but his came on slowly. My brothers has been very quick. Thanks for your help.
Brief Answer:
Read below.
Detailed Answer:
Thank you for that additional information. Rapaflo (Silodosin) is used for prostate enlargement, it does not influence mental status, I do not think it is related.
Dementia can have many causes. The classic one, Alzheimer's disease has a chronic slow course as you say. But there are other types, and also in a patient in the early stages of Alzheimer when exposed to other factors might have a sudden deterioration.
If he's had a long history of alcohol and drug abuse, one should keep in mind that they do leave some residual damage to the brain, and while may not be the direct cause, may make one much more vulnerable to mental status alterations.
The same goes about those old strokes which have been found, they lead to brain volume loss and cognitive impairment. Repeated strokes are a main cause of dementia, called vascular dementia. The damage in this case might not be enough to show evident dementia changes at the time, but if exposed to conditions like fever, dehydration, metabolic disturbances etc, he is more vulnerable, much more prone to decompensate and temporarily deteriorate in an acute manner as I mentioned before.
But of course these are only assumptions, as I said it's tough to evaluate without having more info on what tests he's done.
Read below.
Detailed Answer:
Thank you for that additional information. Rapaflo (Silodosin) is used for prostate enlargement, it does not influence mental status, I do not think it is related.
Dementia can have many causes. The classic one, Alzheimer's disease has a chronic slow course as you say. But there are other types, and also in a patient in the early stages of Alzheimer when exposed to other factors might have a sudden deterioration.
If he's had a long history of alcohol and drug abuse, one should keep in mind that they do leave some residual damage to the brain, and while may not be the direct cause, may make one much more vulnerable to mental status alterations.
The same goes about those old strokes which have been found, they lead to brain volume loss and cognitive impairment. Repeated strokes are a main cause of dementia, called vascular dementia. The damage in this case might not be enough to show evident dementia changes at the time, but if exposed to conditions like fever, dehydration, metabolic disturbances etc, he is more vulnerable, much more prone to decompensate and temporarily deteriorate in an acute manner as I mentioned before.
But of course these are only assumptions, as I said it's tough to evaluate without having more info on what tests he's done.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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