Altered mental status: Difference between revisions

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== Background ==
''This page is for <u>adult</u> altered mental status. See [[altered mental status (peds)]] for the pediatric page.''
*Alteration of arousal or content of consciousness or both
==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  
*Both cerebral cortices or brainstem must be affected  
*[[Delirium]] vs [[dementia]] vs psych
*[[Delirium]] vs [[dementia]] vs other organic pathology vs functional (psychiatric)
*Must quickly determine if coma is from diffuse or focal impairment
*Must quickly determine if coma is from diffuse or focal impairment
*Peds
**Most common causes are toxic ingestion, infection, and child-abuse induced trauma


==Clinical Features==
==Clinical Features==
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**Diffuse brain dysfunction - lack of focal findings
**Diffuse brain dysfunction - lack of focal findings
**Focal brain dysfunction - hemiparesis, loss of motor tone, loss of ocular reflexes
**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.


==DDX==
==Differential Diagnosis==
#Diffuse brain dysfunction
{{AMS DDX}}
##Encephalopathies
###Hypoxic encephalopathy
###Metabolic encephalopathy
####[[Hypoglycemia]]
####Hyperosmolar state (e.g., [[hyperglycemia]])
####[[Electrolyte Abnormalities]] ([[hypernatremia]] or [[hyponatremia]], [[hypercalcemia]])
####Organ system failure
####[[Hepatic Encephalopathy]]
####[[Uremia]]/[[Renal Failure]]
####Endocrine (Addison disease, [[hypothyroidism]])
####Hypoxia
####CO2 narcosis
###[[Hypertensive Encephalopathy]]
##Toxins
##Drug reactions (NMS)
##Environmental causes
###[[Hypothermia]]
###[[Hyperthermia]]
##Deficiency state
###Wernicke Encephalopathy
##[[Sepsis]]
#Primary CNS disease or trauma
##Direct CNS trauma
###Diffuse axonal injury
###Subdural/epidural hematoma
##Vascular disease
###Intraparenchymal hemorrhage
##[[SAH]]
##Infarction
###Hemispheric, brainstem
##CNS infections
##Neoplasms
##[[Seizures]]
###Nonconvulsive status epilepticus
####Consider if motor activity of seizure has stopped but pt is not alert w/in 30min
###Postictal state


==Work-Up==
==Evaluation==
*Head CT
{{AMS workup}}


==Treatment==
==Management==
*Pts w/ focal findings may have surgically treatable cause
*Patients with focal findings may have surgically treatable cause
*Coma cocktail
*Coma cocktail
**Glucose, thiamine, naloxone
**[[Glucose]], [[thiamine]], [[naloxone]]
*Underlying cause
*Treat underlying cause


== See Also ==
==Disposition==
*Most frequently admission, unless of a chronic and known etiology
 
==See Also==
*[[Toxicology (Main)]]  
*[[Toxicology (Main)]]  
*[[Glasgow Coma Scale (GCS)]]
*[[Glasgow Coma Scale (GCS)]]
*[[Altered Mental Status (AMS) (Peds)]]
*[[Altered mental status (peds)]]
*[[AVPU Scale]]
*[[AVPU Scale]]
*[[Brain Death]]
*[[Brain Death]]


== Source  ==
==Video==
Tintinalli
{{#widget:YouTube|id=Sc0ObjHa3VA}}


[[Category:Neuro]]
==References==
<references/>
[[Category:Neurology]]

Revision as of 18:26, 21 March 2019

This page is for adult altered mental status. See altered mental status (peds) for the pediatric page.

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

Video

{{#widget:YouTube|id=Sc0ObjHa3VA}}

References