delirium

[tifosi]

My husband started having delirium last June and was diagnosed with Type 2 Hyperthyroidism from Amiodarone use. He was taken off amio. and was put on 30 mgs. a day of prednisone and the delirium stopped. While being weaned off at the of last year he started having delirium again...but no one put the prednisone weaning and the delirium together, so I was given a lot of different explanations from top doctors as to his delirium, ranging from pain meds. to having been sick most of last year and losing all his reserve in his brain to function normal. In Jan. of this year after he had a gout flare up, he was given prednisone again and became 100% normal. We talked with endocrinology and he was kept at 20 mgs. until a diagnosis can be made and was seen by a neurologist 2 weeks ago, whom ordered many blood tests, MRI and lumbar puncture. Last Tuesday he was scheduled to have eye surgery, on the way to the hospital he was completely normal, shortly after pre-op questioning he became so delirious that the doctor called an ambulance to take him from the surgery area to the ER. Many tests were done and nothing was found, they did a CT scan and the MRI which had been scheduled for Thurs., there was some mild atrophy in his brain, but he had that previously. On Thursday I took him for his lumbar puncture..the only thing that has come back abnormal was his Protein, CSF which was 67. He is still somewhat delirious and is still on 20 mgs. of prednisone. I was wondering what the significance of the protein being high, the prednisone usually bringing him back to normal and the delirium? Also, I am wondering why he would go from being 100% normal a minute to almost completely mentally gone the next? Any help would be appreciated. He has a follow up with the doctor, but they would not tell me anything over the phone...I fear they are just going to send him to another doctor, which has been happening since the 1 delirium attack...that took 2 weeks before they diagnosed the amiodarone type 2 hyperthyroidism. Thanks!

[tifosi]

Thank you so much for your reply. My husband is being seen by almost every type of doctor there is at this point. He had been and is still seeing a team of cardiologists (L transposition of great vessels-congentially corrected), team of ID for his initial illness with infection (MRSA) last year, Nephrologist, Urologist (he has no problems in this area, but did go into renal failure last year due to dehydration and a routine anti-biotic he was to take for life, but the anti-biotic has been changed and no further problems there),  a team of eye specialist (retina became detached due to infection and now has an oil bubble with a cataract), a Wound Specialist, a team of Endo. doctors, Surgical team, Ortho. teamand most recently a Neurologist-more then I could possibly name at this point. He also sees Doctors of Medicine at this hospital, but they are not his primary care physician, who is not associated with the hospital. Every time he is re-admitted to the hospital I also talk with a Pharmacist Specialist to go over the long list of drugs he takes and though it is thought to increase his delirium when he is having it, most every doctor is of the opinion that the meds. are not the cause and there is an underlying condition. The Neurologist told us on Friday that all the tests he had run were normal, including the elevated protein and has ordered Pet Scan and EEG, but does not expect to find much from that. It seems everyone is at a loss, the Neurologist was almost certain that it was one of 3 things with the symptoms he had, but all results for that were negative. As you can tell I am quite frustrated at this point. My husband goes to a hospital that is rated in the top 10 in the US, so it is not some little town hospital that might not have the resources available. While I know the doctors are working hard to find out what is wrong, they have written it off before as his illnesses just being too much for a person to handle and that the delirium would go away after a year. It was not until I noticed the link between the prednisone and the delirium that they are now looking further and my fear is if they find nothing, he will slip into delirium for good. Once again, I appreciate your help...I have never used a forum or even a search engine, I have family members that are doctors and PhD's (though none specialize in any of this...most are in research), I trust the doctors who are treating my husband and if something comes up that seems questionable I normally turn to family, but they are all at a loss as this is not in any of their fields of medicine. I am trying this route with the forum as I refuse to give up...I know there has to be an underlying condition, it might not even be with the brain (but it is not the hypothyroidism, he is not in that anymore, but still sees doctor for regular check ups)...I just have no where else to turn (I should mention I am personal friends with many of my husbands doctors so it also makes it hard to question them if I were to think they are wrong-but I do question them). Once again, thanks from a frustrated with the medical environment at this time...your help is appreciated.

[S. Kaul, MD]

Hi there!

Elevated CSF protein could indicate an underlying process such as infections, inflammations, demyelination, haemorrhage, hypothyroidism etc. At 67 mg/ dl the protein would just be mildly elevated to be of clinical significance and is likely to an association of hypothyroidism. However the clinical improvement seen with steroids could indicate an underlying inflammatory process (in the CNS or elsewhere in the body such as the thyroid gland) and further investigations may be required to arrive at a conclusive diagnosis. I would suggest a detailed evaluation by an internist and a neurologist at this time. After a specific cause is identified, it can be managed accordingly.
Hope this is helpful.

Take care!