Incidence of Dehydration Encephalopathy among Patients with Disturbed Consciousness at a Hospital Emergency Unit

Ogawa, Emina; Sakakibara, Ryuji; Endo, Kei; Tateno, Fuyuki; Mori, Yasuo; Hosoe, Nobuo; Kusumoto, Masahiko; Shirai, Kohji

doi:10.4081/cp.2011.e9

Cited by 3 publications

(2 citation statements)

References 4 publications

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“…Although the underlying mechanisms are not fully understood, concomitant encephalopathy is likely to be a contributing factor. Several non-neurological stroke mimic etiologies such as infections, metabolic/toxic conditions or hypertensive crisis can be associated with encephalopathy [17][18][19][20], which in turn can cause mental status alterations but also focal neurological symptoms such as speech disorders or limb paresis. Clinicians should bear this in mind when investigating patients with suspected stroke and exclude non-neurological causes in uncertain cases.…”

Section: Discussionmentioning

confidence: 99%

Frequency and Characteristics of Non-Neurological and Neurological Stroke Mimics in the Emergency Department

Kühne Escolà,

Bozkurt,

Brune

et al. 2023

JCM

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Background: Stroke mimics are common in the emergency department (ED) and early detection is important to initiate appropriate treatment and withhold unnecessary procedures. We aimed to compare the frequency, clinical characteristics and predictors of non-neurological and neurological stroke mimics transferred to our ED for suspected stroke. Methods: This was a cross-sectional study of consecutive patients with suspected stroke transported to the ED of the University Hospital Essen between January 2017 and December 2021 by the city’s Emergency Medical Service. We investigated patient characteristics, preclinical data, symptoms and final diagnoses in patients with non-neurological and neurological stroke mimics. Multinominal logistic regression analysis was performed to assess predictors of both etiologic groups. Results: Of 2167 patients with suspected stroke, 762 (35.2%) were diagnosed with a stroke mimic. Etiology was non-neurological in 369 (48.4%) and neurological in 393 (51.6%) cases. The most common diagnoses were seizures (23.2%) and infections (14.7%). Patients with non-neurological mimics were older (78.0 vs. 72.0 y, p < 0.001) and more likely to have chronic kidney disease (17.3% vs. 9.2%, p < 0.001) or heart failure (12.5% vs. 7.1%, p = 0.014). Prevalence of malignancy (8.7% vs. 13.7%, p = 0.031) and focal symptoms (38.8 vs. 57.3%, p < 0.001) was lower in this group. More than two-fifths required hospitalization (39.3 vs. 47.1%, p = 0.034). Adjusted multinominal logistic regression revealed chronic kidney and liver disease as independent positive predictors of stroke mimics regardless of etiology, while atrial fibrillation and hypertension were negative predictors in both groups. Prehospital vital signs were independently associated with non-neurological stroke mimics only, while age was exclusively associated with neurological mimics. Conclusions: Up to half of stroke mimics in the neurological ED are of non-neurological origin. Preclinical identification is challenging and a high proportion requires hospitalization. Awareness of underlying etiologies and differences in clinical characteristics is important to provide optimal care.

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Section: Discussionmentioning

confidence: 99%

Frequency and Characteristics of Non-Neurological and Neurological Stroke Mimics in the Emergency Department

Kühne Escolà,

Bozkurt,

Brune

et al. 2023

JCM

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“…The process of aging seems to undo the evolutionary advantage of “portable water” as elderly individuals are known to lose their fluid reservoirs by age-related decrease in both muscle mass and astrocyte density. For example, dehydration was demonstrated to accelerate the progression of AD which is also known to be associated with loss of astrocytes (Ogawa et al, 2011 ; Reyes-Haro et al, 2015 ; Rodríguez-Arellano et al, 2016 ).…”

Section: Hydration and Cognitionmentioning

confidence: 99%

Dehydration and Cognition in Geriatrics: A Hydromolecular Hypothesis

Sfera

Cummings

Osorio

2016

Front. Mol. Biosci.

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Dehydration is one of the ten most frequent diagnoses responsible for the hospital admission of elderly in the United States. It is associated with increased mortality, morbidity and an estimated cost of 1.14 billion per year (Xiao et al., 2004; Schlanger et al., 2010; Pretorius et al., 2013; Frangeskou et al., 2015). Older individuals are predisposed to dehydration encephalopathy as a result of decreased total body water (TBW) and diminished sensation of thirst. We hypothesize that thirst blunting in older individuals is the result of a defective microRNA-6842-3p failing to silence the expression of the vesicular GABA transporters (VGAT) and alpha 7 cholinergic nicotinic receptors in the subfornical organ (SFO) of the hypothalamus. We hypothesize further that resultant dehydration facilitates protein misfolding and aggregation, predisposing to neurocognitive disorders. We completed a search of predicted microRNA targets, utilizing the public domain tool miRDB and found that microRNA-6842-3p modulates the SLC6A1 and CHRNA7 genes both of which were previously hypothesized to inhibit the thirst sensation by their action on SFO. The primary aim of this article is to answer two questions: Can prevention and correction of dehydration in elderly lower age-related cognitive deterioration? Can exosomal miR-6842 in the peripheral blood predict dehydration encephalopathy in elderly?

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