Abstract
Acute confusional states and agitated delirium are among the most common psychopathologic disorders in the elderly. However, they are rarely reported in the course of infacts in the territory of the posterior cerebral artery. This study involving thirteen patients aged more than 65 years suggests that acute confusional states from posterior cerebral artery infarcts are less rare than usually thought, although the diagnosis may be difficult during the acute phase. The risk factors are no different from those observed for infacts in other cortical areas, suggesting that this syndrome is due to structural damage of the brain rather than the other, usual causes of confusion in the elderly (intoxications, dysmetabolic diseases or dementia). The recognition of acute confusional states from posterior cerebral artery infarcts and its distinction from other causes of confusion is important in elderly patients because of the different diagnostic, prognostic and therapeutic implications involved.
Sommario
Gli stati confusionali e deliranti acuti sono tra le manifestazioni psicopatologiche più frequenti nei pazienti anziani. Tuttavia essi sono raramente descritti in corso di infarti nel territorio dell'arteria cerebrale posteriore. Il nostro studio, basato su 13 pazienti di età superiore a 65 anni, suggerisce che stati confusionali o deliranti acuti secondari ad infarti nel territorio dell'arteria cerebrale posteriore in pazienti anziani sono meno rari di quanto generalmente si ritenga, ma la diagnosi clinica quò essere difficile durante la fase acuta. I fattori di rischio non risultano diversi da quelli di altri infarti. indicando che tale sindrome è dovuta al danno strutturale piuttosto che alle altre usuali cause di confusione (intossicazioni, malattie dismetaboliche o demenza). Il riconoscimento degli stati confusionali acuti da infarti della cerebrale posteriore e la loro distinzione da altre cause di confusione in soggetti anziani ha grande importanza a causa delle differenti implicazioni di ordine diagnostico, prognostico e terapeutico.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Adams R.D., Victtor M.:Principles of Neurology, 3rd Ed. New York, Mc Graw Hill International Book Co., 1985.
Amyes E.W., Nielsen J.M.:Clinicopathological study of vascular lesions of the anterior cyngulate region. Bull. Los Angeles Neurol., Soc. 20: 112–130, 1955.
Bear D.M.:Hemispheric specialization and the neurology of emotion. Arch. Neurol. 40: 195–202, 1983.
Beresin E.V.:Delirium in the elderly. J. Geriatr. Psychiatry Neurol. 1: 127–142, 1988.
Bisiach E., Cappa S., Vallar G.:Guida all'esame neuropsicologico. Raffaello Cortina Editore, Milano, 1983.
Caplan L.R., Kelly M., Kase C.S., Hier D.B., White J.L., Tatemichi T., Mohr J., Price T., Wolf P.:Infarcts in the inferior division of the right middle cerebral artery: Mirror image of Wernike's aphasia. Neurology 36: 1015–1020, 1986.
Connor R.C.R.:Complicated migraine. Lancet 2:1072–1075, 1962.
De Renzi E., Zambolin A., Crisi G.:The pattern of neuropsychological impairment associated with left posterior cerebral artery infarcts. Brain 110: 1099–1116, 1987.
Damasio H.:A computed tomographic guide to the identification of cerebral vascular territories. 40: 138–142, 1983.
Devinsky I. O., Bear D., Volpe T.:Confusional states following posterior cerebral artery infarction. Arch. Neurol. 45: 160–163, 1988.
Fisher C.M.:Unusual vascular events in the territory of the posterior cerebral artery. Can. J. Neurol. Sci. 13:1–7, 1986.
Folstein M.F., Folstein S.E., McHugh P.R.:“Mini Mental State”: a practical method for grading the cognitive state of patients for the clinican. J. Psychiatr. Res. 12: 189–198, 1975.
Gloor P. Amygdala. In: J. Field (ed.). Handboolk of Physiology. Section I: Neurophysiology. Washington D.C., American Physiology Society, vol. 2: 1395–1420, 1960.
Headache Classification Committee of the International Headache Society.Classification and diagnostic criteria for headache disorders, cranial neuralgias, and facial pain, Cephalalgia 8: (Suppl. 7): 12–96, 1988.
Levkoff S.E., Besdine R.W., Wetle T.:Acute confusional states (delirium) in the hospitalized elderly. Ann. Rev. Gerontol. Geriatr. 6:1–26, 1986.
Lipowski Z.J.:Current concepts-Geriatrics: Delirium in elderly patients. N. Engl. J. Med. 320:578–582, 1989.
Lipowski Z.J.:Acute confusional states (delirium) in elderly patients. In: Albert M.L. ed. Clinical Neurology of aging. New Yor: Oxford University Press, 277–294, 1984.
Medina J.L., Chokroverty S., Rubino F.:Syndrome of agitated delirium and visual impairment: a manifestation of medial temporo-occipital infarction. J. Neurol. Neurosurg. Psychiatry 40:861–864, 1977.
Mesulam M., Waxman S.G., Geschwind N., Sabin T.:Acute confusional states with right middle cerebral artery infarctions. J. Neurol. Neurosurg. Psychiatry 39:84–89, 1976.
Mones R.J., Christoff N., Bender M.B.:Posterior cerebral artery occlusion. Arch. Neurol. 5:80–88, 1961.
Mori E., Yamadori A.:Acute confusional state and acute agitated delirium. Occurrence after infarction in the right middle cerebral artery territory. Arch. Neurol. 44: 1139–1143, 1987.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Nicolai, A., Lazzarino, L.G. Acute confusional states secondary to infarctions in the territory of the posterior cerebral artery in elderly patients. Ital J Neuro Sci 15, 91–96 (1994). https://doi.org/10.1007/BF02340119
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02340119