Altered mental status

Revision as of 18:07, 21 March 2019 by SLuckettG (talk | contribs) (Background)

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


  • 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

Differential Diagnosis

Altered mental status

Diffuse brain dysfunction

Primary CNS disease or trauma



AMS Workup

Common Orders

Consider Based on Clinical Situation


  • Patients with focal findings may have surgically treatable cause
  • Coma cocktail
  • Treat underlying cause


  • Most frequently admission, unless of a chronic and known etiology

See Also