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

  1. Impairment of arousal and content of consciousness
  2. Generally develops over days
  3. Symptoms may be intermittent and vary in severity

Workup

  1. CBC
  2. Chemistry
  3. LFTs
  4. UA
  5. CXR
  6. ?Utox
  7. ?CT/LP

DDX

  1. Infection
    1. PNA, UTI, meningitis/encephalitis, sepsis
  2. Metabolic
    1. Hypoglycemia
    2. Electrolyte abnormalities
    3. Hepatic encephalopathy
  3. Neuro
    1. TIA/CVA
    2. Seizure or postictal state
    3. SAH/ICH/SDH
    4. CNS mass lesion
  4. Cardiopulmonary
    1. CHF
    2. MI
    3. PE
    4. Hypoxia or CO2 narcosis
  5. Drug-related
    1. ETOH ingestion
    2. ETOH or drug withdrawal
    3. Sedative-hypnotics
    4. Anticholinergics
    5. Narcotics
    6. Polypharmacy

Treatment

  • Treat underlying cause

Dementia

Clinical Features

  1. Loss of mental capacity
  2. Slow and steady course
  3. Hallucinations, delusions, repetitive behaviors, and depression are all common
  4. May coexist w/ delirium
  5. Poor score on Mini-Mental State Exam

DDX

  1. Degenerative
    1. Alzheimer's disease
    2. Huntington's disease
    3. Parkinson's disease
  2. Vascular
    1. Multiple infarcts
    2. Hypoperfusion (MI, profound hypotension)
    3. Subdural hematoma
    4. SAH
  3. Infectious
    1. Meningitis (sequelae of bacterial, fungal, or tubercular)
    2. Neurosyphilis
    3. Viral encephalitis (herpes, HIV), Creutzfeldt-Jakob disease
  4. Inflammatory
    1. SLE
    2. Demyelinating disease
  5. Neoplastic
    1. Primary tumors / metastatic disease
    2. Carcinomatous meningitis
    3. Paraneoplastic syndromes
  6. Traumatic
    1. Traumatic brain injury
    2. Subdural hematoma
  7. Toxic
    1. ETOH
    2. Meds (anticholinergics, polypharmacy)
  8. Metabolic
    1. B12 or folate deficiency
    2. Thyroid disease
    3. Uremia
  9. Psychiatric
    1. Depression (pseudodementia)
  10. Hydrocephalic
    1. Normal-pressure hydrocephalus (communicating hydrocephalus)
    2. Noncommunicating hydrocephalus

Work-Up

  1. Must rule-out treatable causes of dementia / delirium (see DDX)
    1. CBC
    2. Chemistry
    3. LFTs
    4. UA
    5. CXR
    6. ?Utox
    7. ?CT/LP

Treatment

  • Treat underlying cause (if possible)

See Also

Source

Tintinalli

Retrieved from "https://www.wikem.org/w/index.php?title=Altered_mental_status&oldid=6759"