Causes of Delirium

Category

Examples

Neurologic causes

Cerebrovascular disorders

Hemorrhagic stroke, ischemic stroke, transient ischemia attack

Migraine

Confusional migraine*

Inflammation or infection

Acute demyelinating encephalomyelitis, brain abscess, CNS vasculitis, autoimmune encephalopathy, encephalitis, meningitis, meningoencephalitis

Seizure disorders

Nonconvulsive status epilepticus, postictal state

Trauma

Subdural hematoma, traumatic brain injury

Tumor

Meningeal carcinomatosis, primary or metastatic brain tumor

Nonneurologic causes

Medications and recreational drugs (numerous)

Endocrine disorders

Adrenal insufficiency, pituitary insufficiency, Cushing syndrome, hyperparathyroidism, hyperthyroidism, hypothyroidism

Hematologic disorders

Hyperviscosity syndrome, leukemic blast cell crisis, polycythemia, thrombocytosis

Infections

Pneumonia, sepsis, systemic infections, UTIs

Injuries

Burns, electrical injuries, fat embolism, heatstroke, hypothermia

Metabolic disorders

Acid-base disturbances, fluid and electrolyte abnormalities (eg, dehydration, hypercalcemia, hypernatremia, hypocalcemia, hyponatremia, hypomagnesemia), hepatic or uremic encephalopathy, hyperosmolality, hyperglycemia, hypoglycemia, hypoxia, Wernicke encephalopathy

Vascular or circulatory disorders

Anemia, cardiac arrhythmias, heart failure, hypoperfusion states, shock

Vitamin deficiency

Thiamin deficiency, vitamin B12 deficiency

Withdrawal syndromes

Alcohol, barbiturates, benzodiazepines, opioids

Other causes

Change of environment, fever, fecal impaction, hypertensive encephalopathy, liver failure, long stays in an ICU, mental disorders, postoperative states, sensory deprivation, sleep deprivation, hyperthermia, toxins that affect the CNS, urinary retention

* Confusional migraine is characterized by confusion, agitation or lethargy, dysphasia, amnesia, and absence of headache.

CNS = central nervous system; ICU = intensive care unit; NSAIDs - nonsteroidal anti-inflammatory drugs; UTIs = urinary tract infections.