Disease relevance of Confusion

• Ciprofloxacin-induced complex partial status epilepticus manifesting as an acute confusional state [1].
• Postdexamethasone cortisol levels were significantly correlated to the presence of an acute confusional state and to extensive limb paresis (rs = 0.66 and rs = 0.62, respectively; p < 0.05) [2].
• Ciliary disorientation has been proposed as a variant of primary ciliary dyskinesia (PCD); cilia have normal ultrastructure and normal or near normal ciliary beat frequency (CBF) but lack efficacy because their beat direction is disorientated [3].
• Spatial disorientation in Parkinson's disease: no effect of levodopa substitution therapy [4].
• Ciliary disorientation was significantly (p < 0.05) increased in the three patient groups compared with the volunteers, being greatest in the two patients with the clinical features of PCD and in bronchiectasis patients with P. aeruginosa, and was positively correlated (r = 0.9) with MCC but not with CBF [5].

Psychiatry related information on Confusion

• Of 15 patients with psychiatric reactions to lidocaine, 12 (80%) had mood changes, 11 (73%) had "doom anxiety," eight (53%) had overt confusional states, and six (40%) had hallucinations and delusions [6].
• The early appearance of Kluver-Bucy syndrome and the late occurrence of amnesia and spatial disorientation allow clinical identification of this variant of Pick disease [7].
• The features of benzodiazepine withdrawal in the elderly may differ from those seen in young patients; withdrawal symptoms include confusion and disorientation which often does not precipitate milder reactions such as anxiety, insomnia and perceptual changes [8].
• The principal clinical applications are in epilepsy, states of altered consciousness including postanoxic and traumatic coma, the parasomnias, dementias, toxic confusional states, cerebral infections, and various other encephalopathies [9].
• Memory loss, confusion, and disorientation in an elderly woman taking meclizine [10].

High impact information on Confusion

• Phencyclidine hydrochloride (PCP) is a psychoactive drug that in small doses produces agitation, excitement, and disorientation, but in larger doses results in stupor, convulsions, coma, and death [11].
• This occurred especially by an increase of second-order vasa vasorum and disorientation of normal vasa vasorum spatial pattern [12].
• Overexpression of wild-type PDGFA, or inhibition of PDGFA both lead to randomized migration, disorientation of polarized mesodermal cells, decreased movement towards the animal pole, and reduced head formation and axis elongation [13].
• Retinol has no effect and retinal has a small inhibitory effect but neither phenotypic transformation nor axial disorientation were observed [14].
• Disorientation, memory impairment, and psychotic thought processes associated with the CNS lesions were not altered by the propranolol [15].

Chemical compound and disease context of Confusion

• Initial levels of ACTH but not cortisol were significantly increased in patients with acute confusional state and significantly correlated with volume of brain lesion and neurological and functional outcome [16].
• The myelographic contrast agent, metrizamide, causes a temporary confusional state in many patients [17].
• We present three patients who, after long-term therapy with amantadine (4 to 18 years), experienced an acute delirium with confusion, disorientation, agitation, and paranoia on withdrawal [18].
• 5-HIAA levels were mainly related positively to hostility and negatively to somatic concern, and MHPG positively to disorientation and negatively to emotional withdrawal and uncooperativeness [19].
• In an effort to identify patients at risk for behavioral complications, we reviewed 92 patients undergoing ISA evaluation and found five with severe changes in affect and behavior following amobarbital injection, ranging from prolonged coma to an extended confusional state [20].

Biological context of Confusion

• In a multiple regression analysis, urine cortisol values were shown to be positively associated with limb paresis (P = 0.003), disorientation (P = 0.03) and body temperature (P = 0.03) [21].
• Three clinical variables (disorientation, rectal temperature, systolic blood pressure) and three laboratory variables (serum lactate dehydrogenase, potassium, and creatinine values) were highly predictive for hospitalization in recruits with exertional heat illness [22].
• OBJECTIVE: Ciliary orientation (COR) is an important parameter of mucociliary clearance and ciliary disorientation has been reported in cases of acquired abnormalities [secondary ciliary dyskinesia (SCD)] and in a very few cases as the single abnormality in primary ciliary dyskinesia (PCD) [23].

Anatomical context of Confusion

• A 68-year-old woman, who was treated with 5-fluorouracil (5-FU) intravenous therapy weekly for variable periods following hemicolectomy for adenocarcinoma of the cecum, had at least two well-described episodes of mental confusion, disorientation, and deterioration, in the absence of cerebellar tract signs [24].
• These findings suggest that, although cellular activity is maintained in prematurely ruptured membranes, the mainly collagenous extracellular matrix undergoes marked disorientation [25].
• Central nervous system (CNS) toxicity was significant with 30% somnolence, 20% disorientation and an episode of grand-mal epilepsy ascribed to ifosfamide [26].
• CASE SUMMARY: A 72-year-old African American man developed an acute confusional state (ACS) one month after receiving celecoxib for osteoarthritis of his knee joints [27].
• Examination of 1-micron-thick toluidine blue-stained sections of the forebrain and hindbrain region revealed reduced and altered mitotic figures, with dispersion and disorientation of the mitotic layer [28].

Gene context of Confusion

• Mice deficient in Cdk5, p35, or both p35 and p39 display the hallmarks of disturbed cortical development, including cortical layer inversion, neuronal disorientation, and abnormal fiber infiltration [29].
• In a multiple regression model, disorientation was associated with a low thyrotropin response to TRH (P = 0.02 and P = 0.04; 20 and 60 min after TRH, respectively) [30].
• Two siblings had the clinical features of PCD and ciliary disorientation alone on repeated biopsies taken 10 yr apart [3].
• X-ray fiber diffraction patterns of the R-type straight flagellar filament of Salmonella typhimurium SJW1655 strain showed layer-lines with an axial spacing of 1/437 A-1, which could be resolved only due to very small disorientation angles (< 2 degrees) of the filaments in oriented sol specimens [31].
• Since CNS infection with B burgdorferi is usually accompanied by intrathecal synthesis of specific antibody, we studied CSF in 73 patients referred for presumed CNS Lyme, manifested primarily as this confusional state [32].

Analytical, diagnostic and therapeutic context of Confusion

• Five patients examined using metrizamide (3%) experienced transient confusion and disorientation following lumbar myelography [33].
• Prolonged postoperative disorientation after methylene blue infusion during parathyroidectomy [34].
• Two patients treated by chemotherapy for a non-Hodgkin malignant lymphoma developed focal neurological symptoms including disorientation, hemoplegia, and cortical blindness 5 and 15 days after the end of a polychemotherapy course, including methotrexate and vindesine [35].
• Although seizures did not occur at 9 years of age, she manifested dyscalculia, right-left disorientation, and finger agnosia, and N-isopropyl-p-iodoamphetamine single-photon emission computed tomography (SPECT) revealed focal hypoperfusion in the left parietal lobe [36].
• Three patients with cerebral tumor involving diencephalic midline structures (2 malignant gliomas, 1 craniopharyngioma) and no metabolic abnormalities developed disorientation in time and place or coma with triphasic waves (TW) seen on electroencephalograms [37].

References