Metabolic encephalopathy: neurologic and psychiatric considerations

The diagnosis in patients who have psychiatric or neurologic manifestations as the result of toxins of great variety is not particularly difficult and usually can be achieved with a discerning history and physical examination. The EEG is a useful but not a necessary adjunct. The most difficult of these patients to sort out etiologically are those brought into the hospital, without history, in a flaccid coma or wild delirium or with mild or subtle delirium. The dementias are the main differential diagnosis. The hallmarks of metabolic encephalopathy are reduced awareness and fluctuating attention with defects in orientatioN, interpretation, memory, retention, and recall and with hesitant and clumsy motor performance. Prompt treatment is necessary to preserve the integrity of the master organ, the brain. Delay in treatment may convert metabolic encephalopathy into permanent dementia.