PURPOSE: Approximately 5 percent of patients who undergo withdrawal from alcohol suffer from delirium tremens (DTs), a syndrome characterized by hallucinations, disorientation, tachycardia, hypertension, low grade fever, agitation, and diaphoresis. While non-contrast computed tomography scan (CT) of the head is not indicated in DTs it is often done, especially if the patient has seizure or evidence of trauma, features not uncommon in these patients. Our aim was to determine the usefulness of this practice.
METHODS: 196 consecutive admissions for DTs were retrospectively reviewed for clinical presentation, including seizures, signs of trauma, and clinical course. Findings on CT head done on admission were noted.
RESULTS: 90 (45%) patients were deemed uncomplicated (no seizure, and no suspicion or evidence of acute trauma), and no CT head was done. These patients responded to medical treatment without neurological complications. 106 (55%) had a head CT for the following indications: seizure 14 (13%), signs of acute head trauma 17 (16%), suspected trauma (such as being found lying on the street) without signs of acute head trauma 75 (71%). CT head findings relevant to further management were seen in 24 (23%) patients: extra-cranial hematoma 13 (12%), subdural hematoma 4 (4%), old infarct 3 (3%), encephalomalacia 2 (2%), epidural hematoma 1 (1%), and temporal fracture 1 (1%). Findings that mandated changes in management and possible intervention was seen only in the patients with seizure or signs of acute head trauma.
CONCLUSION: CT head scanning is of value in the evaluation of patients with DTs who have seizure or signs of acute head trauma. In such situations findings on head CT can influence further management.
CLINICAL IMPLICATIONS: In the absence of signs of acute head trauma or seizures, CT scan of the head does not improve the evaluation of patients with DTs.
DISCLOSURE: J. Williams, No Financial Disclosure Information; No Product/Research Disclosure Information