title: Distended bladder presenting with altered mental status and venous obstruction.
abstract: BACKGROUND
  New onset or acute worsening of bilateral lower extremity swelling is commonly caused by venous congestion from decompensated heart failure, pulmonary disease, liver dysfunction, or kidney insufficiency. A thromboembolic event, lymphatic obstruction, or even external compression of venous flow can also be the culprit.
  
  
  METHODS
  We report the case of an 83-year-old male with a history of myelodysplastic syndrome that progressed to acute myeloid leukemia, bipolar disorder, and benign prostatic hypertrophy. He presented with altered mental status and new onset lower extremity edema caused by acute bladder outflow obstruction. Computed tomography of the abdomen and pelvis showed the patient's distended bladder compressing bilateral external iliac veins.
  
  
  CONCLUSIONS
  Insertion of a Foley catheter resulted in several liters of urine output and marked improvement in his lower extremity edema and mental status a few hours later. Our extensive workup failed to reveal a cause of the patient's acute change in mental status, and we attributed it to a concept known as cystocerebral syndrome.
authors.affiliation: Department of Internal Medicine, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Vaughan
authors.initials: V
authors.lastname: Washco
authors.affiliation: Department of Internal Medicine, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Lee
authors.initials: L
authors.lastname: Engel
authors.affiliation: Department of Radiology, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: David L
authors.initials: DL
authors.lastname: Smith
authors.affiliation: Department of Internal Medicine, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Ross
authors.initials: R
authors.lastname: McCarron
keywords: Cystocerebral syndrome; edema; urethral obstruction; urinary retention; venous thromboembolism
references.citation: Mayo Clin Proc. 1995 Nov;70(11):1077-9
references.pmid: 7475337
references.citation: BJU Int. 2006 Apr;97 Suppl 2:16-20; discussion 21-2
references.pmid: 16507048
references.citation: Vasc Med. 2006 Nov;11(4):263-5
references.pmid: 17390552
references.citation: J Am Geriatr Soc. 2008 Dec;56(12):2371-2
references.pmid: 19093953
references.citation: J Med Case Rep. 2012 Jan 24;6:34
references.pmid: 22272565
references.citation: Cochrane Database Syst Rev. 2014 Jun 10;(6):CD006744
references.pmid: 24913721
references.citation: Arch Intern Med. 1990 Dec;150(12):2577-8
references.pmid: 2244775
references.citation: BJU Int. 2005 Feb;95(3):354-7
references.pmid: 15679793
references.citation: N Engl J Med. 1995 Jan 12;332(2):75-9
references.pmid: 7527493
references.citation: Tijdschr Gerontol Geriatr. 2001 Jun;32(3):100-3
references.pmid: 11455868
references.citation: Acta radiol. 1960 Jun;53:449-53
references.pmid: 13807782
references.citation: Aging (Milano). 2001 Aug;13(4):339-42
references.pmid: 11695503
references.citation: Arch Intern Med. 1991 Sep;151(9):1884, 1886
references.pmid: 1888260
references.citation: N Engl J Med. 2003 Dec 18;349(25):2387-98
references.pmid: 14681504
references.citation: Emerg Med Clin North Am. 2001 Aug;19(3):591-619
references.pmid: 11554277