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Chapter 21: Neurocognitive Disorders
Table 21.2-7
Physical Examination of the Delirious Patient
Parameter
Finding
Clinical Implication
1. Pulse
Bradycardia
Hypothyroidism
Stokes-Adams syndrome
Increased intracranial pressure
Tachycardia
Hyperthyroidism
Infection
Heart failure
2. Temperature
Fever
Sepsis
Thyroid storm
Vasculitis
3. Blood pressure
Hypotension
Shock
Hypothyroidism
Addison’s disease
Hypertension
Encephalopathy
Intracranial mass
4. Respiration
Tachypnea
Diabetes
Pneumonia
Cardiac failure
Fever
Acidosis (metabolic)
Shallow
Alcohol or other substance intoxication
5. Carotid vessels
Bruits or decreased pulse
Transient cerebral ischemia
6. Scalp and face
Evidence of trauma
7. Neck
Evidence of nuchal rigidity
Meningitis
Subarachnoid hemorrhage
8. Eyes
Papilledema
Tumor
Hypertensive encephalopathy
Pupillary dilatation
Anxiety
Autonomic overactivity (e.g., delirium tremens)
9. Mouth
Tongue or cheek lacerations
Evidence of generalized tonic-clonic seizures
10. Thyroid
Enlarged
Hyperthyroidism
11. Heart
Arrhythmia
Inadequate cardiac output, possibility of emboli
Cardiomegaly
Heart failure
Hypertensive disease
12. Lungs
Congestion
Primary pulmonary failure
Pulmonary edema
Pneumonia
13. Breath
Alcohol
Ketones
Diabetes
14. Liver
Enlargement
Cirrhosis
Liver failure
15. Nervous system
a. Reflexes—muscle stretch
Asymmetry with Babinski’s signs Mass lesion
Cerebrovascular disease
Preexisting dementia
Snout
Frontal mass
Bilateral posterior cerebral artery occlusion
b. Abducent nerve (sixth cranial nerve)
Weakness in lateral gaze
Increased intracranial pressure
c. Limb strength
Asymmetrical
Mass lesion
Cerebrovascular disease
d. Autonomic
Hyperactivity
Anxiety
Delirium
(From Strub RL, Black FW.
Neurobehavioral Disorders: A Clinical Approach
. Philadelphia: FA Davis; 1981:121, with permission.)
