Delirium. A comprehensive review.

Delirium is among the most common potentially preventable neurological disorders encountered in diverse patient populations, especially in critical care units and the elderly. It may present with highly variable clinical features, prolong hospital stay, and herald a poor prognosis. It is also a source of distress for patients and their caregivers. A high degree of clinical suspicion is required for detecting delirium and a detailed history, physical examination, and targeted investigations are necessary to determine the underlying etiology and ensure proper management. The following article is a comprehensive review outlining the various aspects of delirium.

Cerebral venous sinus thrombosis in Saudi Arabia.

OBJECTIVE: To analyze the clinical patterns, etiologies, treatment, and outcome of cerebral venous sinus thrombosis (CVST) in 2 major cities of Saudi Arabia, Jeddah and Al-Baha. METHODS: One hundred and eleven patients diagnosed as CVST were identified from the medical records at King Abdulaziz Medical City, Jeddah, and King Fahad Hospital, Al-Baha, Saudi Arabia, from January 1990 through November 2010. We retrospectively analyzed the data, compared it with local and international studies, and reviewed the literature. RESULTS: There were 92 adults and 19 children. Among adults, females predominated, while more boys were affected than girls. The mean age of onset was 29.5 years. The most common clinical presentations were headache, focal neurologic deficits, seizures, papilledema, and decreased level of consciousness. The main risk factors identified were pregnancy/ puerperium, antiphospholipid antibody syndrome, oral contraceptive pills, malignancy, and infections. Multiple sinuses were affected in 51 patients (45.9%). When a single sinus was involved, the superior sagittal sinus (24.3%) was the most common. Seventy-four patients recovered completely, 23 patients recovered partially, and 10 patients died. Bad prognostic factors included incurable co-morbid conditions, late presentation, and status epilepticus. CONCLUSION: Pregnancy/puerperium was the most common etiological factor in our series. Clinical features were similar to international series. Behcet`s disease was not a major etiological factor in our series. Most patients had involvement of multiple sinuses. Prompt treatment with anticoagulation resulted in complete or partial recovery in 87.4% of patients.

Inability to walk due to scurvy: A forgotten disease.

Scurvy has become rare in modern societies, but should be considered in malnourished persons, alcoholics, and in infants on unsupplemented milk diets who present with musculoskeletal pain or a bleeding tendency. The diagnosis of scurvy can be challenging because of the rare incidence and vague and nonspecific early symptoms. We report here a case of scurvy in a young boy who presented with an inability to walk and severe musculoskeletal pain. The diagnosis was established based on his clinical picture, radiological appearance, and low serum level of vitamin C. The patient responded well to vitamin C supplementation with full resolution of his symptoms. He regained his ability to walk and his family was happy and satisfied with the outcome of treatment. Although the incidence of scurvy has become low in Saudi Arabia, it can still occur and early recognition is important because of the excellent prognosis.