What Role Does Delirium Play in Criminal Cases?

Courtesy of Godoy Medical Forensics


In many of our cases we come across symptoms of delirium and are asked to determine if they are due to the assumed etiology, like alcohol or drug intoxication; or from something else, like seizures, or traumatic brain injury. So, this month I’d like to do an overview of delirium and its potential causes, and in future newsletters I’ll go more in depth on some of the underlying etiologies. A review of your case by a medical expert is prudent to differentiate the symptoms and their underlying cause but this should give you a good overview as to whether you should consider hiring an expert.

What is delirium?

Delirium is a disruption in brain functioning from a physiologic cause. Symptoms include mental status changes such as impaired awareness, memory loss, confusion and difficulty staying focused. Other symptoms include hallucinations, delusions, agitation, changes in speech (fast or nonsensical). Finally, a range of awareness from hypervigilant to obtunded is often observed.

What causes delirium?

Delirium can be from a number of etiologies including: (Stern, et al., 2010)

  • Withdrawal: specifically, abrupt withdrawal of alcohol, sedative hypnotics, or narcotics.
  • Wernicke’s Encephalopathy: a neurological disorder associated with alcoholism.
  • Hypoxia: low oxygen in the blood.
  • Hypoperfusion: blood isn’t getting to the brain, possible causes are volume loss, shock.
  • Hypoglycemia: low blood sugar.
  • Hypertensive crisis: extremely high blood pressure.
  • Intracranial processes: such as strokes, hemorrhages or tumors.
  • Infection: systemic infection or brain infection.
  • Metabolic Causes: electrolyte changes, thyroid, liver or kidney dysfunction.
  • Poisoning: can be purposeful or accidental, street drugs, medications, toxins.
  • Seizures: Many seizures may result in delirium during the seizure or its postictal state.

Does delirium resolve on its own?

It depends greatly on its underlying cause: Some require treatment, some will resolve with time. The amount of time it takes for delirium to resolve is also dependent on its underlying cause and the treatment rendered.