Altered mental status: Difference between revisions
No edit summary |
No edit summary |
||
| Line 1: | Line 1: | ||
==Background== | == Background == | ||
*Alteration of arousal or content of consciousness or both | *Alteration of arousal or content of consciousness or both | ||
*Both cerebral cortices or brainstem must be affected | *Both cerebral cortices or brainstem must be affected | ||
*Delirium vs dementia vs psych | *Delirium vs dementia vs psych | ||
===Delirium=== | === Delirium === | ||
====Clinical Features==== | ==== Clinical Features ==== | ||
#Impairment of arousal and content of consciousness | #Impairment of arousal and content of consciousness | ||
#Generally develops over days | #Generally develops over days | ||
#Symptoms may be intermittent and vary in severity | #Symptoms may be intermittent and vary in severity | ||
====Workup==== | ==== Workup ==== | ||
#CBC | #CBC | ||
#Chemistry | #Chemistry | ||
#LFTs | #LFTs | ||
#UA | #UA | ||
#CXR | #CXR | ||
#?Utox | #?Utox | ||
#?CT/LP | #?CT/LP | ||
====DDX==== | ==== DDX ==== | ||
#Infection | #Infection | ||
##PNA, UTI, meningitis/encephalitis, sepsis | ##PNA, UTI, meningitis/encephalitis, sepsis | ||
#Metabolic | #Metabolic | ||
##Hypoglycemia | ##Hypoglycemia | ||
##Electrolyte abnormalities | ##Electrolyte abnormalities | ||
##Hepatic encephalopathy | ##Hepatic encephalopathy | ||
#Neuro | #Neuro | ||
##TIA/CVA | ##TIA/CVA | ||
##Seizure or postictal state | ##Seizure or postictal state | ||
##SAH/ICH/SDH | ##SAH/ICH/SDH | ||
##CNS mass lesion | ##CNS mass lesion | ||
#Cardiopulmonary | #Cardiopulmonary | ||
##CHF | ##CHF | ||
##MI | ##MI | ||
##PE | ##PE | ||
##Hypoxia or CO2 narcosis | ##Hypoxia or CO2 narcosis | ||
#Drug-related | #Drug-related | ||
##ETOH ingestion | ##ETOH ingestion | ||
##ETOH or drug withdrawal | ##ETOH or drug withdrawal | ||
##Sedative-hypnotics | ##Sedative-hypnotics | ||
##Anticholinergics | ##Anticholinergics | ||
##Narcotics | ##Narcotics | ||
##Polypharmacy | ##Polypharmacy | ||
====Treatment==== | ==== Treatment ==== | ||
*Treat underlying cause | *Treat underlying cause | ||
===Dementia=== | === Dementia === | ||
====Clinical Features==== | ==== Clinical Features ==== | ||
#Loss of mental capacity | #Loss of mental capacity | ||
#Slow and steady course | #Slow and steady course | ||
#Hallucinations, delusions, repetitive behaviors, and depression are all common | #Hallucinations, delusions, repetitive behaviors, and depression are all common | ||
#May coexist w/ delirium | #May coexist w/ delirium | ||
#Poor score on Mini-Mental State Exam | #Poor score on Mini-Mental State Exam | ||
====DDX==== | ==== DDX ==== | ||
#Degenerative | #Degenerative | ||
##Alzheimer's disease | ##Alzheimer's disease | ||
##Huntington's disease | ##Huntington's disease | ||
##Parkinson's disease | ##Parkinson's disease | ||
#Vascular | #Vascular | ||
##Multiple infarcts | ##Multiple infarcts | ||
##Hypoperfusion (MI, profound hypotension) | ##Hypoperfusion (MI, profound hypotension) | ||
##Subdural hematoma | ##Subdural hematoma | ||
##SAH | ##SAH | ||
#Infectious | #Infectious | ||
##Meningitis (sequelae of bacterial, fungal, or tubercular) | ##Meningitis (sequelae of bacterial, fungal, or tubercular) | ||
##Neurosyphilis | ##Neurosyphilis | ||
##Viral encephalitis (herpes, HIV), Creutzfeldt-Jakob disease | ##Viral encephalitis (herpes, HIV), Creutzfeldt-Jakob disease | ||
#Inflammatory | #Inflammatory | ||
##SLE | ##SLE | ||
##Demyelinating disease | ##Demyelinating disease | ||
#Neoplastic | #Neoplastic | ||
##Primary tumors / metastatic disease | ##Primary tumors / metastatic disease | ||
##Carcinomatous meningitis | ##Carcinomatous meningitis | ||
##Paraneoplastic syndromes | ##Paraneoplastic syndromes | ||
#Traumatic | #Traumatic | ||
##Traumatic brain injury | ##Traumatic brain injury | ||
##Subdural hematoma | ##Subdural hematoma | ||
#Toxic | #Toxic | ||
##ETOH | ##ETOH | ||
##Meds (anticholinergics, polypharmacy) | ##Meds (anticholinergics, polypharmacy) | ||
#Metabolic | #Metabolic | ||
##B12 or folate deficiency | ##B12 or folate deficiency | ||
##Thyroid disease | ##Thyroid disease | ||
##Uremia | ##Uremia | ||
#Psychiatric | #Psychiatric | ||
##Depression (pseudodementia) | ##Depression (pseudodementia) | ||
#Hydrocephalic | #Hydrocephalic | ||
##Normal-pressure hydrocephalus (communicating hydrocephalus) | ##Normal-pressure hydrocephalus (communicating hydrocephalus) | ||
##Noncommunicating hydrocephalus | ##Noncommunicating hydrocephalus | ||
====Work-Up==== | ==== Work-Up ==== | ||
#Must rule-out treatable causes of dementia / delirium (see DDX) | #Must rule-out treatable causes of dementia / delirium (see DDX) | ||
##CBC | ##CBC | ||
##Chemistry | ##Chemistry | ||
##LFTs | ##LFTs | ||
##UA | ##UA | ||
##CXR | ##CXR | ||
##?Utox | ##?Utox | ||
##?CT/LP | ##?CT/LP | ||
====Treatment==== | ==== Treatment ==== | ||
*Treat underlying cause (if possible) | *Treat underlying cause (if possible) | ||
==See Also== | == See Also == | ||
*[[Toxidromes]] | *[[Toxidromes]] | ||
*[[Glasgow Coma Scale (GCS)]] | *[[Glasgow Coma Scale (GCS)]] | ||
*[[Altered Mental Status (AMS) (Peds)]] | |||
==Source == | == Source == | ||
Tintinalli | Tintinalli | ||
[[Category:Neuro]] | [[Category:Neuro]] | ||
Revision as of 17:24, 15 November 2011
Background
- Alteration of arousal or content of consciousness or both
- Both cerebral cortices or brainstem must be affected
- Delirium vs dementia vs psych
Delirium
Clinical Features
- Impairment of arousal and content of consciousness
- Generally develops over days
- Symptoms may be intermittent and vary in severity
Workup
- CBC
- Chemistry
- LFTs
- UA
- CXR
- ?Utox
- ?CT/LP
DDX
- Infection
- PNA, UTI, meningitis/encephalitis, sepsis
- Metabolic
- Hypoglycemia
- Electrolyte abnormalities
- Hepatic encephalopathy
- Neuro
- TIA/CVA
- Seizure or postictal state
- SAH/ICH/SDH
- CNS mass lesion
- Cardiopulmonary
- CHF
- MI
- PE
- Hypoxia or CO2 narcosis
- Drug-related
- ETOH ingestion
- ETOH or drug withdrawal
- Sedative-hypnotics
- Anticholinergics
- Narcotics
- Polypharmacy
Treatment
- Treat underlying cause
Dementia
Clinical Features
- Loss of mental capacity
- Slow and steady course
- Hallucinations, delusions, repetitive behaviors, and depression are all common
- May coexist w/ delirium
- Poor score on Mini-Mental State Exam
DDX
- Degenerative
- Alzheimer's disease
- Huntington's disease
- Parkinson's disease
- Vascular
- Multiple infarcts
- Hypoperfusion (MI, profound hypotension)
- Subdural hematoma
- SAH
- Infectious
- Meningitis (sequelae of bacterial, fungal, or tubercular)
- Neurosyphilis
- Viral encephalitis (herpes, HIV), Creutzfeldt-Jakob disease
- Inflammatory
- SLE
- Demyelinating disease
- Neoplastic
- Primary tumors / metastatic disease
- Carcinomatous meningitis
- Paraneoplastic syndromes
- Traumatic
- Traumatic brain injury
- Subdural hematoma
- Toxic
- ETOH
- Meds (anticholinergics, polypharmacy)
- Metabolic
- B12 or folate deficiency
- Thyroid disease
- Uremia
- Psychiatric
- Depression (pseudodementia)
- Hydrocephalic
- Normal-pressure hydrocephalus (communicating hydrocephalus)
- Noncommunicating hydrocephalus
Work-Up
- Must rule-out treatable causes of dementia / delirium (see DDX)
- CBC
- Chemistry
- LFTs
- UA
- CXR
- ?Utox
- ?CT/LP
Treatment
- Treat underlying cause (if possible)
See Also
Source
Tintinalli