Cystocerebral Syndrome: A Possible Explanation-Reply

In Reply. —  Our original intent in submitting our observations of the "cystocerebral syndrome" to the Archives¹ was to offer other physicians the opportunity to confirm these findings and propose a specific mechanism by which an acute confusional state could result from urinary obstruction. Since the publication of this article, over a dozen physicians have made us aware that they have seen this phenomenon fairly commonly. The comments by Liem and Carter are very relevant and deserve further consideration.Blunting of the effects of catecholamine stimulation of the cardiovascular system occurs as part of the aging process.^2-4 Increases in heart rate, ejection fraction, and rate of ejection are diminished during catecholamine stimulation. The arterial system is less capable of dilating in response to a β-adrenergic stimulus, although arterial tone and systolic blood pressure may still increase via the α receptors.Acute bladder distention, either alone or in combination