Difference between revisions of "Altered mental status"

(Background)
 
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''This page is for <u>adult</u> altered mental status. See [[altered mental status (peds)]] for the pediatric page.''
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{{Adult top}} [[altered mental status (peds)]]
 
==Background==
 
==Background==
 
*Acute alteration in brain function
 
*Acute alteration in brain function
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*Both cerebral cortices or brainstem must be affected  
 
*Both cerebral cortices or brainstem must be affected  
 
*[[Delirium]] vs [[dementia]] vs other organic pathology vs functional (psychiatric)
 
*[[Delirium]] vs [[dementia]] vs other organic pathology vs functional (psychiatric)
*Must quickly determine if coma is from diffuse or focal impairment
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*Must quickly determine if [[coma]] is from diffuse or focal impairment
  
 
==Clinical Features==
 
==Clinical Features==
 
*Depends on cause
 
*Depends on cause
 
**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
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**[[focal neuro deficits|Focal brain dysfunction]] - hemiparesis, loss of motor tone, loss of ocular reflexes
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*Important to differentiate diffuse brain dysfunction from localized lesion as a patient may appear confused due to visual deficit, dysphasia, etc.
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
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*Patients with focal findings may have surgically treatable cause
 
*Patients with focal findings may have surgically treatable cause
 
*Coma cocktail
 
*Coma cocktail
**[[Glucose]], [[thiamine]], [[naloxone]]
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**[[dextrose|Glucose]], [[thiamine]], [[naloxone]]
 
*Treat underlying cause
 
*Treat underlying cause
  
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<references/>
 
<references/>
 
[[Category:Neurology]]
 
[[Category:Neurology]]
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[[Category:Symptoms]]

Latest revision as of 22:48, 28 November 2019

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

Video

References