mecanismos fisiopatológicos do delirium pathophysiological mechanisms of delirium
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2005
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Abstract
O delirium é uma das síndromes mais fascinantes na medicina, apesar de pobremente compreendida. Apesar de sua ocorrência freqüente e de haver crescente informação sobre o diagnóstico, fenomenologia, epidemiologia e etiologias, estudos sobre os mecanismos que mediam a fisiopatologia são, freqüentemente, ausentes. O desenvolvimento de sofisticadas metodologias de imagem cerebral tem permitido ir além das considerações diagnósticas e investigar a neurobiologia dos sintomas específicos observados no delirium. Esses avanços na neuropsiquiatria e na neuroimagem têm revelado diferenças entre as regiões cerebrais, incluindo os hemisférios. O delirium é uma síndrome que pode ocorrer como o resultado de múltipla e complexa interação entre sistemas de neurotransmissores e processos patológicos. Os neurotransmissores, acetilcolina e serotonina, podem ter participação importante no delirium devido a condições clínicas comuns, bem como no delirium pós-cirúrgico. Outros neurotransmissores (dopamina e GABA) e fatores neurobiológicos tais como citocinas, hormônios e radicais livres precisarão de mais estudos para definir as suas participações na gênese do delirium. Futuros estudos, centralizados na fisiopatologia do delirium, poderão levar a melhores estratégias de prevenção e tratamento.
Delirium is one of the most fascinating and poorly understood syndromes in medicine. Despite its frequent occurrence and growing information on diagnosis, phenomenology, epidemiology, and aetiologies, studies on mediating pathophysiological mechanisms in delirium are largely lacking. The emergence of sophisticated brain imaging methodologies has made it possible to move beyond diagnostic consideration and investigate the neurobiology of specific symptom clusters observed in delirium. Advances in neuropsychiatry and neuroimaging have revealed differences between brain regions, including the hemispheres. Delirium is a syndrome that may occur as the result of multiple complex interacting neurotransmitter systems and pathologic processes. The neurotransmitters acetylcholine and serotonin may play particularly important roles in common medical and surgical delirium. Others neurotransmitters such as dopamine and GABA and neurobiologic factors such as cytokines, cortisol abnormalities, and oxygen free radicals will require further study to define their role in delirium. Distinct neuropathologic processes leading to delirium are beginning to be defined. Further situation-specific studies of delirium pathophysiology should lead more effective prevention and treatment strategies.
Delirium is one of the most fascinating and poorly understood syndromes in medicine. Despite its frequent occurrence and growing information on diagnosis, phenomenology, epidemiology, and aetiologies, studies on mediating pathophysiological mechanisms in delirium are largely lacking. The emergence of sophisticated brain imaging methodologies has made it possible to move beyond diagnostic consideration and investigate the neurobiology of specific symptom clusters observed in delirium. Advances in neuropsychiatry and neuroimaging have revealed differences between brain regions, including the hemispheres. Delirium is a syndrome that may occur as the result of multiple complex interacting neurotransmitter systems and pathologic processes. The neurotransmitters acetylcholine and serotonin may play particularly important roles in common medical and surgical delirium. Others neurotransmitters such as dopamine and GABA and neurobiologic factors such as cytokines, cortisol abnormalities, and oxygen free radicals will require further study to define their role in delirium. Distinct neuropathologic processes leading to delirium are beginning to be defined. Further situation-specific studies of delirium pathophysiology should lead more effective prevention and treatment strategies.
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santos2005archivesmecanismos
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| Authors | ;Franklin Santana Santos |
| Journal | arthritis research & therapy |
| Year | 2005 |
| DOI |
10.1590/S0101-60832005000300002
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