Table 2

Common and important causes and precipitants of delirium

Primary acute neurological disorders
 Infective
 Meningitis, encephalitis, abscess
 Vascular
  Subarachnoid haemorrhage
  Infarction and intracerebral haemorrhage2-150
  Subdural
  Venous thrombosis
 Neoplastic
  Multiple metastases2-150
  Primary CNS tumours2-150
  Malignant meningitis
 Epilepsy
  Non-convulsive status
 Head injury
 Inflammatory
  Multiple sclerosis2-150
 Vasculitis2-150
Systemic disorders
 Metabolic and nutritional
  Hyponatraemia, hypernatraemia, hypercalcaemia
  Hypoxia
  Cerebral hypoperfusion
  Hypoglycaemia, hyperglycaemia
  Porphyria
  Acidosis
  Thiamine deficiency
 Endocrine
  Hypothyroidism, hyperthyroidism, Cushing's, hyperparathyroidism
 Infection
  Particularly urinary tract and chest infections
Extrinsic factors
 Drugs
  Especially anticholinergics, steroids, anaesthesia
 Drug withdrawal
 Other toxins
  Solvents, carbon monoxide, heavy metals
 Pain, especially after fractures
 Constipation and urinary retention
 Urinary retention
  • 2-150 Focal signs likely to dominate clinical picture