Delayed arousal.
Elderly patients have medical and psychological problems affecting all major organ systems. These problems may alter the pharmacokinetics and/or pharmacodynamics of medications, or expose previous neurologic deficits simply as a result of sedation. Delayed arousal, therefore, may arise from structural problems that are pre-existent or new, or metabolic or functional disorders such as convulsive or nonconvulsive seizures. Determining the cause of delayed arousal may require clinical, chemical, and structural tests. Structural problems that impair consciousness arise from a small number of focal lesions to specific areas of the central nervous system, or from pathology affecting the cerebrum. In general, focal or multifocal lesions can be identified by computerized tomography, or diffusion-weighted imaging. An algorithm is presented that outlines a workup for an elderly patient with delayed arousal.
Anastasian
Zirka H
ZH
Division of Neurosurgical Anesthesiology, Department of Anesthesiology, Columbia University, New York, NY 10032, USA. zh2114@columbia.edu
Ornstein
Eugene
E
Heyer
Eric J
EJ
D000368:Aged; D000762:Anesthesia Recovery Period; D001143:Arousal / Q000187:drug effects / Q000502:physiology*; D001921:Brain / Q000502:physiology; D003243:Consciousness / Q000187:drug effects / Q000502:physiology; D005260:Female; D006801:Humans; D009434:Neural Pathways / Q000502:physiology; D009464:Neuroma, Acoustic / Q000150:complications / Q000601:surgery; D011183:Postoperative Complications / Q000628:therapy*; D012640:Seizures / Q000150:complications