In a prospective study of 1,500 neurologic consultations during 1978 and 1984 within the Johns Hopkins Hospital, iatrogenic neurologic conditions were found in 14 percent of patients. The most common antecedents were angiography, cardiac surgery, and immunosuppression. Neurologists found previously unsuspected significant neurologic conditions in 27 percent of patients. Determining the underlying causes of delirium posed a special diagnostic problem. The accuracy of general physicians and surgeons in the application of criteria for brain death was low. Consultations for solely medical-legal reasons are increasing. These findings indicate the need for improved surveillance of neurological injury in hospitals, earlier recognition of delirium and research into its mechanisms, and additional education about criteria for brain death.
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