Dim at the Top ?

 So you’ve just seen a patient with confusion and abnormal behaviour.

  • Where do you start ?
  • What are the causes ?

Consider are they dim at the top (DIMTOPPE) ?

DIMTOPPE is a handy mnemonic that comprehensively covers the causes of CNS dysfunction.

  •  D = Drugs & Toxins
    • Extrinsic toxins
    • Intrinsic toxins
      • liver failure
      • CCF
      • renal failure
      • respiratory failure
  • I = Infection
    • CNS
    • outside CNS
  • M = Metabolic & Endocrine
    • Hypoglycaemia
    • Hyponatraemia
    • Hypo- or Hyperthyroidism
  • T = Trauma
  • O = Oxygen deficiency
    • Localised eg CVA (thrombotic or haemorrhagic)
    • Global hypoxia (eg pneumonia)
  • P =  Post-ictal state
  • P = Psychiatric / Psychogenic
  • E = oEdema of the brain
    • Hypertensive encephalopathy
    • Space-Occupying Lesion

Thanks to Colin for this one taken from his talk on Paediatric Neurological assessment.

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2 thoughts on “Dim at the Top ?

  1. altered, mental state, decreased, conscious state, organic brain syndrome, drowsiness, seizure, lethargy

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  2. you forgot wernicke

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