Altered mental status: Difference between revisions

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==Overall Causes==
{{Adult top}} [[altered mental status (peds)]]
# Delirium
==Background==
# Dementia
*Acute alteration in brain function
# Psych
**May include alteration of arousal or awareness, thought content, memory, or attention
*Both cerebral cortices or brainstem must be affected
*[[Delirium]] vs [[dementia]] vs other organic pathology vs functional (psychiatric)
*Must quickly determine if [[coma]] is from diffuse or focal impairment


==Workup/Treatment==
==Clinical Features==
# Check glucose/SaO2 --> correct
*Depends on cause
# Focal neuro def --> R/O CVA/mass/bleed
**Diffuse brain dysfunction - lack of focal findings
# Fever --> positive = find source
**[[focal neuro deficits|Focal brain dysfunction]] - hemiparesis, loss of motor tone, loss of ocular reflexes
# Obvious cause --> positive = pursue
*Important to differentiate diffuse brain dysfunction from localized lesion as a patient may appear confused due to visual deficit, dysphasia, etc.
# Non-obvious -->


#Give thiamine & narcan
==Differential Diagnosis==
#CBC
{{AMS DDX}}
#Chem 10
#UA
#ECG
#UTox
#CXR
#Head CT
#LFTs
#PT


Consider:
==Evaluation==
#CSF
{{AMS workup}}
#ABG
#TSH
#EEG
#ASA/Tylenol levels
#Ammonia
#HIV


==DDx Confusion==
==Management==
# Hypoxia/diffuse ischemia
*Patients with focal findings may have surgically treatable cause
## Respiratory failure
*Coma cocktail
## CHF
**[[dextrose|Glucose]], [[thiamine]], [[naloxone]]
## MI
*Treat underlying cause
## Severe anemia
## Shock
# Systemic
## Hypoglycemia
## Electrolyte/fluid disturbance
## Endocrine dz
### Thyroid
### Adrenal
## Hepatic failure (ammonia)
## Wernicke's
## Infection/sepsis
### Urine
### PNA
### Other
# CNS Disease
## Infection
## Trauma
## CVA/TIA
## SAH
## Seizure
### Postictal
### Nonconvulsive
### Complex partial
# Hypertensive encephalopathy
# Increased ICP
# Toxins/withdrawal
## Sedatives
## ETOH
## Anticholinergics
## Other
# Neoplasm


==DDx Coma and...==
==Disposition==
===DIFFUSE CNS DYSFUNCTION===
*Most frequently admission, unless of a chronic and known etiology
# Diffuse Neuronal Deprivation
## Hypoglycemia
## Hypoxia (with nl Cerebral Blood Flow (CBF))
### Respiratory failure
#### CHF
#### PNA
#### Obstructive
### Severe anemia
## Decreased CBF
### Shock
#### AMI
#### Hypovolemia
### Post arrest
## Cellular Toxin
### CO
### Cyanide
### Hydrogen sulfide
## Thiamine deficiency (Wernicke-Korsakoff)
# Endogenous CNS Toxins
## Hyperammonemia (hepatic coma)
## Uremia (renal failure)
## CO2 Narcosis
## Hyperglycemia
# Exogenous CNS Toxins
## Alcohols
### ETOH
### Isopropyl
## Acids
### Methanol
### Ethylene glycol
### Salicylate
## Sedatives
## Narcotics
## Anticonvulsants
## Psychotropics
## Isoniazid
## Heavy metals
# Endocrine disorders
## Myxedema coma
## Thyrotoxicosis
## Addison's
## Cushing's
## Pheochromocytoma
# Ionic abnormalities
## Hypo/hyper-natremia
## Hypo/hyper-calcemia
## Hypo/hyper-magnesemia
## Hypophosphatemia
## Acidosis/alkalosis
# Temperature abnormalities
## Hypothermia
## Heat stroke
## NMS
## Malignant hyperthermia
# Intracranial HTN
## Hypertensive encephalopathy
## Pseudotumor cerebri
# CNS inflammation/infection
## Meningitis
## Encephalitis
## Cerebral vasculitis
## SAH
## Carcinoid meningitis
## Traumatic axonal shear
# Primay neuronal/glial
## CJD
# Seizure/postical


===FOCAL CNS LESION===
==See Also==
# Supratentorial
*[[Toxicology (Main)]]
## Hemorrhage
*[[Glasgow Coma Scale (GCS)]]
### Intracerebral
*[[Altered mental status (peds)]]
### Epidural
*[[AVPU Scale]]
### Subdural
*[[Brain Death]]
### Pituitary apoplexy
## Infarction
### Thrombotic arterial
### Embolic arterial
### Venous
## Tumors
## Abscess
# Infratentorial
## Compressive
### Cerebellar hemorrhage
### Post fossa sub/extra-dural
### Cerebellar infarct
### Cerebellar tumor
### Cerebellar abscess
### Basilar aneurysm
## Destructive
### Pontine hemorrhage
### Brainstem infarct
### Basilar migraine
### Brainstem demyelination


==Source ==
==References==
2/27/06 DONALDSON (adapted from Rosen)
<references/>
 
[[Category:Neurology]]
[[Category:Neuro]]
[[Category:Symptoms]]

Latest revision as of 22:45, 27 March 2024

This page is for adult patients. For pediatric patients, see: altered mental status (peds)

Background

  • Acute alteration in brain function
    • May include alteration of arousal or awareness, thought content, memory, or attention
  • Both cerebral cortices or brainstem must be affected
  • Delirium vs dementia vs other organic pathology vs functional (psychiatric)
  • Must quickly determine if coma is from diffuse or focal impairment

Clinical Features

  • Depends on cause
    • Diffuse brain dysfunction - lack of focal findings
    • Focal brain dysfunction - hemiparesis, loss of motor tone, loss of ocular reflexes
  • Important to differentiate diffuse brain dysfunction from localized lesion as a patient may appear confused due to visual deficit, dysphasia, etc.

Differential Diagnosis

Altered mental status

Diffuse brain dysfunction

Primary CNS disease or trauma

Psychiatric

Evaluation

AMS Workup

Common Orders

Consider Based on Clinical Situation

Management

  • Patients with focal findings may have surgically treatable cause
  • Coma cocktail
  • Treat underlying cause

Disposition

  • Most frequently admission, unless of a chronic and known etiology

See Also

References

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