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.