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A short thread on Cystocerebral Syndrome:
About a month ago I posted a crazy case w/ image on a gentleman with severe dementia who came in w/ worsening AMS. We found that he had Phlegmasia cerulea dolens (see below) from a severely distended bladder. Why the AMS though?
About a month ago I posted a crazy case w/ image on a gentleman with severe dementia who came in w/ worsening AMS. We found that he had Phlegmasia cerulea dolens (see below) from a severely distended bladder. Why the AMS though?
I thought it was likely due to the pain he was experiencing. He didn't have a UTI.
It wasn't until I listened to the @thecurbsiders recent episode with @aoglasser (who nailed the dx) on Post Op care, https://thecurbsiders.com/podcast/219
What is Cystocerebral Syndrome?
It wasn't until I listened to the @thecurbsiders recent episode with @aoglasser (who nailed the dx) on Post Op care, https://thecurbsiders.com/podcast/219
What is Cystocerebral Syndrome?
It is described as encephalopathy resulting from bladder distension and responding rapidly to bladder decompression
UTI is conventionally considered a sufficient cause of AMS, a recent review seriously questions the mechanistic role of UTI in AMS https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.13851#jgs13851-bib-0006
UTI is conventionally considered a sufficient cause of AMS, a recent review seriously questions the mechanistic role of UTI in AMS https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.13851#jgs13851-bib-0006
A complementary brain–bladder interaction is though to occur through
sympathetic tone 2/2 to bladder wall distention https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.13851#jgs13851-bib-0007
We also know that bladder wall B-receptors are activated during bladder wall relaxation and filling https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.13851#jgs13851-bib-0007
sympathetic tone 2/2 to bladder wall distention https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.13851#jgs13851-bib-0007We also know that bladder wall B-receptors are activated during bladder wall relaxation and filling https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.13851#jgs13851-bib-0007
When some has a severe obstruction, central & peripheral adrenergic responses lead to catecholamine release
All of this will contribe to confusion & agitation, particularly in individuals w/ underlying cognitive deficits
catecholamine releaseAll of this will contribe to confusion & agitation, particularly in individuals w/ underlying cognitive deficits
A study in 
(yes they have to make an appearance when @aoglasser is mentioned) found an increase in locus coeruleus norepinephrine release & hyperarousal in those with bladder distention.
https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.13851#jgs13851-bib-0008 https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.13851#jgs13851-bib-0009
(yes they have to make an appearance when @aoglasser is mentioned) found an increase in locus coeruleus norepinephrine release & hyperarousal in those with bladder distention.https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.13851#jgs13851-bib-0008 https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.13851#jgs13851-bib-0009
Yes I am sure there is more than one mechanism at play.
But just knowing that the existence of bladder‐mediated sympathetic activation as the reason for his AMS is fascinating and raises the awareness of the dynamic interaction between bladder & brain.
But just knowing that the existence of bladder‐mediated sympathetic activation as the reason for his AMS is fascinating and raises the awareness of the dynamic interaction between bladder & brain.
Here is a great case report that I used to learn, https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.13851
A big thanks to @sargsyanz who helped lead a submission for this case to NEJM. Hopefully they agree.
A big thanks to @sargsyanz who helped lead a submission for this case to NEJM. Hopefully they agree.
This was his follow up image status post foley a few minutes later.
