Hypopituitarism in normal-pressure hydrocephalus.

Hypothalamic hypopituitarism has been associated with the intermittent intracranial hypertension of "normal-pressure" hydrocephalus. Six patients with this condition were studied endocrinologically; five showed evidence of hypothalamohypophyseal insufficiency, and, though only one needed treatment, all needed continued assessment of their endocrine state during follow-up. Thus, hypothalamohypophyseal dysfunction is more common than might be expected. Tests of anterior pituitary function should be preformed before surgical intervention, as such dysfunction may adversely affect survival and the response to ventricular shunting.     

Diagnosis and Treatment of Delirium

Delirium is not a clinical entity but a symptom-complex of manifold etiology. Its presence signifies acute cerebral insufficiency and often represents a medical and/or psychiatric emergency.Though some forms of delirium have distinctive features, the fundamental phenomena are common to all, with clouding of consciousness the sine qua non. The condition has two major components: (1) the basic “acute brain syndrome” and (2) associated release phenomena.Clinicians must first make the vital differentiation between delirium and “functional” mental disorder, then proceed with the elucidation of the underlying diagnosis and the concurrent organization of symptomatic and etiologic treatment.Proper treatment combines management of the acute brain syndrome with general and specific procedures for control of the underlying condition. Dealing with the symptom-complex itself involves the principles and practice of sedation, hydration, and nutrition, nursing care and supportive measures. Provided the basic organic condition is treatable, the prognosis today is usually good.