Transient cognitive impairment

Catatonia is a rare complication of prolonged epidural opioid administration in cancer pain (SEDA-16, 78). Patients with advanced cancer who were taking opioids had significant but transient cognitive impairment when opioid doses were increased (31). This correlates well with studies of the effects of psychotropic medications on ability to drive (32). 

Povidone-iodine (betadine) use in pleurodesis for malignant pleural effusions exhibits a good safety profile pi ]. However, adverse effects of postoperative delirium, hallucinations, transient cognitive impairment occurred following a single application of povidone-iodine to the sternal wound of a cardiac patient. Serum iodine was elevated threefold compared to preoperative levels suggesting caution in use of povidone-iodine [22 ]. 

In DLB, fluctuations in both the level of consciousness and in the content of consciousness (hallucinations and delusions) develop. These alterations, together with much of the ensuing cognitive impairment, fluctuate to such an extent that patients can transiently return to being symptom-free in the course of the disease. This temporal pattern implicates functional as opposed to structural neuropathological abnormalities in symptom aetiology. Several neurotransmitter correlates have been identified in autopsy tissue from retrospectively, and more recently, prospectively assessed patients. 

Starting doses and escalation The adverse effects of morphine, especially cognitive impairment, occur transiently and abate spontaneously there are no reports of a relation between the starting dose of morphine or dose escalation and the occurrence of nausea, vomiting, or delirium. 

Common but usually transient side effects are lethargy, incoordination, blurred vision, higher cortical dysfunction, and drowsiness. At concentrations greater than 50 mcg/mL, phenytoin can exacerbate seizures. Chronic side effects include gingival hyperplasia, impaired cognition, hirsutism, vitamin D deficiency, osteomalacia, folic acid deficiency, carbohydrate intolerance, hypothyroidism, and peripheral neuropathy. 

Transient organic mental syndrome characterized by global impairment of cognition, including memory and perception. 

Clinical concern Transient hypothyroxinemia of prematurity (THOP) occiu s in 50% of extremely low gestational age neonates (ELGANs 24-28 weeks) and is a major factor of neurodevelopment abnormalities (cognitive delay, cerebral palsy, hearing loss, mental retardation, blindness or epilepsy) [9 ]. THOP characterised by very low total and free T4 levels and normal TSH may be safely treated with continuous infusion of 4 gg/kg/day levothyroxine for 42 days to produce a biochemical euthyroid state (phase I/II trials) [1(P]. There is a pressing need for a phase III trial of thyroid hormone that is of sufficient duration and size to determine whether a clinically important reduction in risk of developmental impairments in ELGANs can be achieved [11 ]. 

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