• G Warshaw and F Tanzer.
• Department of Family Medicine, University of Cincinnati Ohio Medical Center.
• Arch Fam Med. 1993 Mar 1; 2 (3): 293-7.

ObjectiveTo determine the value of the cerebrospinal fluid examination in the evaluation of hospitalized; elderly patients with delirium and fever.DesignA retrospective case series of consecutive events during a 15-month period.SettingTertiary care center.ParticipantsElderly patients admitted to the University of Cincinnati (Ohio) Hospital between July 1, 1988, and October 1, 1989, who had a lumbar puncture and cerebrospinal fluid evaluation to evaluate fever and mental status changes.Main Outcome MeasuresPrimary intracranial causes and the clinical characteristics of delirium and fever.ResultsEighty-one hospital admissions were reviewed. Fifty-seven (70%) of the lumbar punctures were performed as part of the admitting workup, and the remaining 24 (30%) were performed during the hospitalization. Eighty of the 81 cerebrospinal fluid cultures were negative for bacterial growth. The primary origins for fever and delirium included urinary tract infections (25%), pneumonia (22%), viral causes (17%), and metabolic causes/dehydration (14%). One case of bacterial meningitis was diagnosed in an alcoholic, 73-year-old man who was unresponsive in the emergency department. One case of presumed aseptic meningitis was diagnosed in a 65-year-old man who presented with fever and headaches and a blood pressure of 230/100 mm Hg.ConclusionsMost hospitalized, older patients with fever and delirium have primary causes of the confusion outside the central nervous system and may not require a routine evaluation of their cerebrospinal fluid.

34 keywords...

hide…