Altered mental status: Difference between revisions

(Created page with "==Overall Causes== 1) Delirium 2) Dementia 3) Psych ==Workup/Treatment== 1. Check glucose/SaO2 --> correct 2. Focal neuro def --> R/O CVA/mass/bleed 2. Fever --> posi...")
 
No edit summary
Line 1: Line 1:
==Overall Causes==
==Overall Causes==
 
# Delirium
 
# Dementia
1) Delirium
# Psych
 
2) Dementia
 
3) Psych
 


==Workup/Treatment==
==Workup/Treatment==
# Check glucose/SaO2 --> correct
# Focal neuro def --> R/O CVA/mass/bleed
# Fever --> positive = find source
# Obvious cause --> positive = pursue
# Non-obvious -->


 
#Give thiamine & narcan
1. Check glucose/SaO2 --> correct
#CBC
 
#Chem 10
2. Focal neuro def --> R/O CVA/mass/bleed
#UA
 
#ECG
2. Fever --> positive = find source
#UTox
 
#CXR
3. Obvious cause --> positive = pursue
#Head CT
 
#LFTs
4. Non-obvious -->
#PT
 
 
Give thiamine & narcan
 
CBC
 
Chem 10
 
UA
 
ECG
 
UTox
 
CXR
 
Head CT
 
LFTs
 
PT
 


Consider:
Consider:
 
#CSF
CSF
#ABG
 
#TSH
ABG
#EEG
 
#ASA/Tylenol levels
TSH
#Ammonia
 
#HIV
EEG
 
ASA/Tylenol levels
 
Ammonia
 
HIV
 


==DDx Confusion==
==DDx Confusion==
 
# Hypoxia/diffuse ischemia
 
## Respiratory failure
I. Hypoxia/diffuse ischemia
## CHF
 
## MI
    A. Respiratory failure
## Severe anemia
 
## Shock
    B. CHF
# Systemic
 
## Hypoglycemia
    C. MI
## Electrolyte/fluid disturbance
 
## Endocrine dz
    D. Severe anemia
### Thyroid
 
### Adrenal
    E. Shock
## Hepatic failure (ammonia)
 
## Wernicke's
II. Systemic
## Infection/sepsis
 
### Urine
    A. Hypoglycemia
### PNA
 
### Other
    B. Electrolyte/fluid disturbance
# CNS Disease
 
## Infection
    C. Endocrine dz
## Trauma
 
## CVA/TIA
          1. Thyroid
## SAH
 
## Seizure
          2. Adrenal
### Postictal
 
### Nonconvulsive
    D. Hepatic failure (ammonia)
### Complex partial
 
# Hypertensive encephalopathy
    E. Wernicke's
# Increased ICP
 
# Toxins/withdrawal
    F. Infection/sepsis
## Sedatives
 
## ETOH
          1. Urine
## Anticholinergics
 
## Other
          2. PNA
# Neoplasm
 
          3. Other
 
III. CNS Disease
 
    A. Infection
 
    B. Trauma
 
    C. CVA/TIA
 
    D. SAH
 
    E. Seizure
 
          1. Postictal
 
          2. Nonconvulsive
 
          3. Complex partial
 
IV. Hypertensive encephalopathy
 
V. Increased ICP
 
VI. Toxins/withdrawal
 
    A. Sedatives
 
    B. ETOH
 
    C. Anticholinergics
 
    D. Other
 
VII. Neoplasm
 


==DDx Coma and...==
==DDx Coma and...==
===DIFFUSE CNS DYSFUNCTION===
# 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===
# Supratentorial
 
## Hemorrhage
DIFFUSE CNS DYSFUNCTION
### Intracerebral
 
### Epidural
I. Diffuse Neuronal Deprivation
### Subdural
 
### Pituitary apoplexy
    A. Hypoglycemia
## Infarction
 
### Thrombotic arterial
    B. Hypoxia (with nl Cerebral Blood Flow (CBF))
### Embolic arterial
 
### Venous
          1. Respiratory failure
## Tumors
 
## Abscess
              a. CHF
# Infratentorial
 
## Compressive
              b. PNA
### Cerebellar hemorrhage
 
### Post fossa sub/extra-dural
              c. Obstructive
### Cerebellar infarct
 
### Cerebellar tumor
          2. Severe anemia
### Cerebellar abscess
 
### Basilar aneurysm
    C. Decreased CBF
## Destructive
 
### Pontine hemorrhage
          1. Shock
### Brainstem infarct
 
### Basilar migraine
              a. AMI
### Brainstem demyelination
 
              b. Hypovolemia
 
          2. Post arrest
 
    D. Cellular Toxin
 
          1. CO
 
          2. Cyanide
 
          3. Hydrogen sulfide
 
    E. Thiamine deficiency (Wernicke-Korsakoff)
 
II. Endogenous CNS Toxins
 
    A. Hyperammonemia (hepatic coma)
 
    B. Uremia (renal failure)
 
    C. CO2 Narcosis
 
    D. Hyperglycemia
 
III. Exogenous CNS Toxins
 
    A. Alcohols
 
          1. ETOH
 
          2. Isopropyl
 
    B. Acids
 
          1. Methanol
 
          2. Ethylene glycol
 
          3. Salicylate
 
    C. Sedatives
 
    D. Narcotics
 
    E. Anticonvulsants
 
    F. Psychotropics
 
    G. Isoniazid
 
    H. Heavy metals
 
IV. Endocrine disorders
 
    A. Myxedema coma
 
    B. Thyrotoxicosis
 
    C. Addison's
 
    D. Cushing's
 
    E. Pheochromocytoma
 
V. Ionic abnormalities
 
    A. Hypo/hyper-natremia
 
    B. Hypo/hyper-calcemia
 
    C. Hypo/hyper-magnesemia
 
    D. Hypophosphatemia
 
    E. Acidosis/alkalosis
 
VI. Temperature abnormalities
 
    A. Hypothermia
 
    B. Heat stroke
 
    C. NMS
 
    D. Malignant hyperthermia
 
VII. Intracranial HTN
 
    A. Hypertensive encephalopathy
 
    B. Pseudotumor cerebri
 
VIII. CNS inflammation/infection
 
    A. Meningitis
 
    B. Encephalitis
 
    C. Cerebral vasculitis
 
    D. SAH
 
    E. Carcinoid meningitis
 
    F. Traumatic axonal shear
 
IX. Primay neuronal/glial
 
    A. CJD
 
X. Seizure/postical
 
 
FOCAL CNS LESION
 
I. Supratentorial
 
    A. Hemorrhage
 
          1. Intracerebral
 
          2. Epidural
 
          3. Subdural
 
          4. Pituitary apoplexy
 
    B. Infarction
 
          1. Thrombotic arterial
 
          2. Embolic arterial
 
          3. Venous
 
    C. Tumors
 
    D. Abscess
 
II. Infratentorial
 
    A. Compressive
 
          1. Cerebellar hemorrhage
 
          2. Post fossa sub/extra-dural
 
          3. Cerebellar infarct
 
          4. Cerebellar tumor
 
          5. Cerebellar abscess
 
          6. Basilar aneurysm
 
    B. Destructive
 
          1. Pontine hemorrhage
 
          2. Brainstem infarct
 
          3. Basilar migraine
 
          4. Brainstem demyelination
 


==Source ==
==Source ==
2/27/06 DONALDSON (adapted from Rosen)
2/27/06 DONALDSON (adapted from Rosen)


[[Category:Neuro]]
[[Category:Neuro]]

Revision as of 05:59, 28 March 2011

Overall Causes

  1. Delirium
  2. Dementia
  3. Psych

Workup/Treatment

  1. Check glucose/SaO2 --> correct
  2. Focal neuro def --> R/O CVA/mass/bleed
  3. Fever --> positive = find source
  4. Obvious cause --> positive = pursue
  5. Non-obvious -->
  1. Give thiamine & narcan
  2. CBC
  3. Chem 10
  4. UA
  5. ECG
  6. UTox
  7. CXR
  8. Head CT
  9. LFTs
  10. PT

Consider:

  1. CSF
  2. ABG
  3. TSH
  4. EEG
  5. ASA/Tylenol levels
  6. Ammonia
  7. HIV

DDx Confusion

  1. Hypoxia/diffuse ischemia
    1. Respiratory failure
    2. CHF
    3. MI
    4. Severe anemia
    5. Shock
  2. Systemic
    1. Hypoglycemia
    2. Electrolyte/fluid disturbance
    3. Endocrine dz
      1. Thyroid
      2. Adrenal
    4. Hepatic failure (ammonia)
    5. Wernicke's
    6. Infection/sepsis
      1. Urine
      2. PNA
      3. Other
  3. CNS Disease
    1. Infection
    2. Trauma
    3. CVA/TIA
    4. SAH
    5. Seizure
      1. Postictal
      2. Nonconvulsive
      3. Complex partial
  4. Hypertensive encephalopathy
  5. Increased ICP
  6. Toxins/withdrawal
    1. Sedatives
    2. ETOH
    3. Anticholinergics
    4. Other
  7. Neoplasm

DDx Coma and...

DIFFUSE CNS DYSFUNCTION

  1. Diffuse Neuronal Deprivation
    1. Hypoglycemia
    2. Hypoxia (with nl Cerebral Blood Flow (CBF))
      1. Respiratory failure
        1. CHF
        2. PNA
        3. Obstructive
      2. Severe anemia
    3. Decreased CBF
      1. Shock
        1. AMI
        2. Hypovolemia
      2. Post arrest
    4. Cellular Toxin
      1. CO
      2. Cyanide
      3. Hydrogen sulfide
    5. Thiamine deficiency (Wernicke-Korsakoff)
  2. Endogenous CNS Toxins
    1. Hyperammonemia (hepatic coma)
    2. Uremia (renal failure)
    3. CO2 Narcosis
    4. Hyperglycemia
  3. Exogenous CNS Toxins
    1. Alcohols
      1. ETOH
      2. Isopropyl
    2. Acids
      1. Methanol
      2. Ethylene glycol
      3. Salicylate
    3. Sedatives
    4. Narcotics
    5. Anticonvulsants
    6. Psychotropics
    7. Isoniazid
    8. Heavy metals
  4. Endocrine disorders
    1. Myxedema coma
    2. Thyrotoxicosis
    3. Addison's
    4. Cushing's
    5. Pheochromocytoma
  5. Ionic abnormalities
    1. Hypo/hyper-natremia
    2. Hypo/hyper-calcemia
    3. Hypo/hyper-magnesemia
    4. Hypophosphatemia
    5. Acidosis/alkalosis
  6. Temperature abnormalities
    1. Hypothermia
    2. Heat stroke
    3. NMS
    4. Malignant hyperthermia
  7. Intracranial HTN
    1. Hypertensive encephalopathy
    2. Pseudotumor cerebri
  8. CNS inflammation/infection
    1. Meningitis
    2. Encephalitis
    3. Cerebral vasculitis
    4. SAH
    5. Carcinoid meningitis
    6. Traumatic axonal shear
  9. Primay neuronal/glial
    1. CJD
  10. Seizure/postical

FOCAL CNS LESION

  1. Supratentorial
    1. Hemorrhage
      1. Intracerebral
      2. Epidural
      3. Subdural
      4. Pituitary apoplexy
    2. Infarction
      1. Thrombotic arterial
      2. Embolic arterial
      3. Venous
    3. Tumors
    4. Abscess
  2. Infratentorial
    1. Compressive
      1. Cerebellar hemorrhage
      2. Post fossa sub/extra-dural
      3. Cerebellar infarct
      4. Cerebellar tumor
      5. Cerebellar abscess
      6. Basilar aneurysm
    2. Destructive
      1. Pontine hemorrhage
      2. Brainstem infarct
      3. Basilar migraine
      4. Brainstem demyelination

Source

2/27/06 DONALDSON (adapted from Rosen)

Retrieved from "https://www.wikem.org/w/index.php?title=Altered_mental_status&oldid=1727"