Cystocerebral Syndrome: An Updated Review and a New Proposed Mechanism for an Often Forgotten Cause of Delirium.

Stephanie Tzarnas,Mackenzie Kramer,Nathaniel R Rosal,Franklin L Thelmo,Laura Walters

doi:10.7759/cureus.11034

Abstract

Cystocerebral syndrome is an often forgotten cause of delirium in elderly males, which is quite easily treated. We reviewed the current body of literature documenting cystocerebral syndrome and proposed a new mechanism of action explaining why all patients identified thus far have been male.Data was obtained from articles describing cases of cystocerebral syndrome, urinary retention, and confusion in addition to delirium via a PubMed database search. We reviewed all articles describing cases of cystocerebral syndrome via the PubMed database using the Medical Subject Headings (MeSH) keywords of "cystocerebral syndrome,” urinary retention and confusion," and "delirium and urinary retention or cystocerebral syndrome," and identified eight cases of cystocerebral syndrome including the original publication by Blackburn and Dunn.We found that all patients reported in the literature were males older than 70 years and often with concomitant benign prostatic hypertrophy (BPH) who presented with acute episodes of delirium that rapidly responded to bladder decompression.The authors seek to update the medical community regarding this uncommon phenomenon of delirium in elderly male patients. We also propose that the lack of female patients in the literature is reflective of their decreased intraurethral flow resistance as is currently being described in other avenues of research in the field of urodynamics.

Highlights

BackgroundDelirium is a term that is often used interchangeably with altered mental status, encephalopathy, and a confusional state
We found that all patients reported in the literature were males older than 70 years and often with concomitant benign prostatic hypertrophy (BPH) who presented with acute episodes of delirium that rapidly responded to bladder decompression
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, delirium is an acute disturbance in attention, cognition, perception, and/or language from a patient’s baseline directly due to another medical condition [1]

Summary

Introduction

Delirium is a term that is often used interchangeably with altered mental status, encephalopathy, and a confusional state. As the bladder outlet pressures remain elevated, the detrusor muscle attempts to continue relaxing via the upregulation of peripheral receptor β-activation from the sympathetic nervous system This excess catecholamine surge leads to encephalopathy, with features similar to patients experiencing a significant stressor such as in sepsis [4,5]. The inability to micturate leads to excess stimulation of the locus coeruleus, which has been demonstrated to result in hyperarousal [6] This feed-forward cycle leads to an elevation of stress metabolites causing patients to become confused, agitated, paranoid, and disoriented. Male patients appear to be uniquely affected by this phenomenon as is evidenced by our literature review This is most likely due to cystocerebral syndrome being the result of increased intraurethral pressures in the setting of BPH. Equation 1: here “R” is representative of resistance to flow and is related to the inherent viscosity of the fluid “η” and length of tube “L” and inversely against “π” and the “r” radius of the tube

Literature review

Conclusions

Disclosures

12. Waardenburg IE