Stupor: Difference between revisions

Latest revision as of 23:00, 10 January 2020

For patient information, click here Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Stupor is the lack of critical cognitive function and level of consciousness wherein a sufferer is almost entirely unresponsive and only responds to base stimuli such as pain. Akinesis and mutism are present but with relative preservation of conscious awareness. A person is also rigid and mute and only appears to be conscious as the eyes are open and follow surrounding objects (Gelder, Mayou and Geddes 2005).

Historical Perspective

The word derives from the Latin stupure, meaning insensible.

Causes

Causes by Organ System

Cardiovascular	Arrhythmia, Basilar occlusion, Bilateral anterior cerebral artery occlusion, Bilateral internal carotid occlusion, Cardiac arrest, Cardiogenic shock, Cerebral vasculitis, Congestive heart failure, Disseminated intravascular coagulation, Fat embolism, Heart failure, Hypertensive crisis, Hypertensive encephalopathy, Hypotension, Massive or bilateral supratentorial infarction, Myocardial infarction, Nonbacterial thrombotic endocarditis , Pontine hemorrhage, Sagittal sinus thrombosis, Stroke, Subacute bacterial endocarditis, Syncope, Thrombophlebitis, Vascular diseases
Chemical / poisoning	2-aminopyridine, 3-aminopyridine , Alcohol abuse , Alicyclic hydrocarbons , Alzheimer's disease, Amphetamines, Antifreeze , Antipsychotics, Anxiolytics, Bottlebrush buckeye poisoning, California buckeye poisoning , Carbon monoxide, Cologne , Common poppy poisoning , Cyanide, Cycad nut poisoning , Deoderant , Ethylene glycol, Hair bleach , Hair dye , Heavy metals, Hydrocarbons, Incense , Lead, Mayapple poisoning , Methanol, Milkweed poisoning , Oil-based paint, Paraldehyde, Pergolide, Propylene glycol , Red buckeye poisoning , Sodium monofluoroacetate
Dermatologic	Heat stroke
Drug Side Effect	Anticholinergics, Anticonvulsants, Antidepressants, Antipsychotics, Anxiolytics, Barbiturates, Bromides, Bromoform , Depilatories , Lithium, Lsd, Morphine overdose , Nabilone, Narcotics, Opiates, Phencylidine, Psychotropics, Salicylate, Sedatives, Thallium, Tranquilizers
Ear Nose Throat	No underlying causes
Endocrine	Addisonian crisis, Aftershave , Hyperparathyroidism , Hyperthyroidism, Hypothyroidism, Pituitary apoplexy, Waterhouse-friderichsen syndrome
Environmental	Heavy metals, hypothermia
Gastroenterologic	Hepatic encephalopathy, Hereditary carnitine deficiency syndrome , Liver encephalopathy , Liver failure, Variant cjd
Genetic	Hallervorden-spatz disease , Porphyria
Hematologic	Aminoacidemia, Aneurysm, Brainstem hemorrhage, Brainstem infarction, Carnitine deficiency, Hypercalcemia, Hypercapnia, Hypercarbia, Hyperglycemia, Hyperglycerolemia, Hypergylcemic nonketotic coma, Hypermagnesemia, Hyperthermia, Hypocalcemia, Hypoglycemia, Hypothermia, Hypoxia, Intracerebral bleed, Lactic acidosis, Leukoencephalopathy, Monoamine oxidase inhibitors, Multifocal leukoencephalopathy, Respiratory acidosis , Sepsis, Stroke, Subacute sclerosing leukoencephalitis, Subarachnoid hemorrhage, Subdural hemorrhage bilateral, Thalamic hemorrhage, Thrombotic thrombocytopenic purpura, Vitamin d deficiency
Iatrogenic	Overdose of anxiolytics, antidepressants, antipsychotics, anticonvulsants, narcotics, opiates, sedatives, Dialysis encephalopathy,
Infectious Disease	Bacterial meningitis, Bartonellosis , Brain abscess, Cerebral abscess, Cerebral malaria, Herpes simplex encephalitis, Infectious disease, Malaria, Malignant buotonneuse fever , Postinfectious encephalomyelitis, Rickettsial disease , Serratia meningitis , Subacute bacterial endocarditis, Subdural empyema, Syphilis, Typhoid fever, Typhus , Variant cjd , Viral encephalitis, Waterhouse-friderichsen syndrome
Musculoskeletal / Ortho	No underlying causes
Neurologic	Acute disseminated encephalomyelitis, Aneurysm, Apraxia, Bacterial meningitis, Benign astrocytoma , Bilateral anterior cerebral artery occlusion, Brain abscess, Brain tumor, Brainstem hemorrhage, Brainstem infarction, Brainstem thrombencephalitis, Bristowe's syndrome , Catatonia, Catatonic depression, Catatonic schizophrenia, Central pontine myelinolysis, Cerebral abscess, Cerebral malaria, Cerebral vasculitis, Coma, Concussion, Conversion disorder, Creutzfeldt-jakob disease, Dementia, Depression, Dialysis encephalopathy, Dysarthria, Exhaustion, Fainting, Fatal familial insomnia , Gjessing's syndrome, Hallervorden-spatz disease , Hereditary carnitine deficiency syndrome , Herpes simplex encephalitis, Hydrocephalus, Hypertensive encephalopathy, Intracerebral bleed, Japanese encephalitis , Listlessness, Liver encephalopathy , Malaise, Marchiafava-bignami disease , Massive or bilateral supratentorial infarction, Meningitis, Midline brainstem tumor, Multiple sclerosis, Neuroleptic malignant syndrome , Nonconvulsive status epilepticus, Ophthalmoparesis, Postictal seizure, Postinfectious encephalomyelitis, Prostration, Psychotropics, Reye's encephalopathy, Seizure, Sensory ataxic neuropathy, Serratia cerebral abscess , Serratia meningitis , Subacute sclerosing leukoencephalitis, Subarachnoid hemorrhage, Subdural empyema, Subdural hemorrhage bilateral, Syncope, Thalamic hemorrhage, Trauma-contusion, Unilateral hemispheric mass, Viral encephalitis, Wernicke's encephalopathy
Nutritional / Metabolic	Diabetic ketoacidosis, Vitamin d deficiency
Obstetric/Gynecologic	No underlying causes
Oncologic	Brain tumor, Bristowe's syndrome , Midline brainstem tumor, Tumor
Opthalmologic	Lesions of the ascending reticular activation system , Ophthalmoparesis
Overdose / Toxicity	Alcohol abuse , Amphetamines, Ativan overdose , Barbiturates, California buckeye poisoning , Darvocet overdose , Dilaudid overdose , Disulfiram toxicity , Lsd, Morphine overdose , Mushrooms, Opiates
Psychiatric	Bell mania, Mental illness, Puerperal psychosis , Schizophrenia, Severe depression
Pulmonary	COPD, hypercarbia, hypoxia due to a wide variety of lung diseases,
Renal / Electrolyte	Acid-base imbalance, Adrenal leukodystrophy, Diabetic ketoacidosis, Hypernatremia, Hyponatremia, Kidney failure, Renal insufficiency, Respiratory acidosis
Rheum / Immune / Allergy	No underlying causes
Sexual	Syphilis
Trauma	Concussion, Heat stroke, Hyperthermia, Hypothermia, Near drowning, Trauma-contusion
Urologic	Uremia
Miscellaneous	No underlying causes

Causes in Alphabetical Order

Differentiating Stupor from other Diseases

Stupor is not the same thing as a coma or a vegetative state. For example, some people who become injured suddenly with a concussion or some other cognitive impairment resulting from injury enter a stupor, where they are partially aware of their surroundings, or they become unconscious until they are revived by themselves or by others. Stupor may be mistaken for delirium and may be treated with Haldol and / or other anti-psychotic drugs.

Diagnosis

History and Symptoms

If not stimulated externally, a patient with stupor will be in a sleepy mode most of the time. In some extreme cases of severe depressive disorders the patient can become motionless, lose their appetite and become mute. Short periods of restricted responsivity can be achieved by intense stimulation (e.g. pain, bright light, loud noise).

Questions about the patients medical history and symptoms should include:

Time pattern
- When did the decreased alertness happen?
- How long did it last?
- Has it ever happened before? If so, how many times?
- Did the person behave the same way during past episodes?
Medical history
- Does the person have epilepsy or a seizure disorder?
- Does the person have diabetes?
- Has the person been sleeping well?
- Has there been a recent head injury?
Other
- What medications does the person take?
- Does the person use alcohol or drugs on a regular basis?
- What other symptoms are present?

CT

Lesions of the Ascending Reticular Activation System on height of the pons and metencephalon have been shown to cause stupor. The incidence is higher after left-sided lesions.

Treatment

Treatment depends on the cause of the decreased alertness. How well a person does depends on the cause of the condition.

Related Chapters

Torpor

References

Template:Cognition, perception, emotional state and behaviour symptoms and signs

Template:Skin and subcutaneous tissue symptoms and signs Template:Nervous and musculoskeletal system symptoms and signs Template:Urinary system symptoms and signs Template:Cognition, perception, emotional state and behaviour symptoms and signs Template:Speech and voice symptoms and signs Template:General symptoms and signs

Template:WikiDoc Sources

v t e Symptoms and signs: circulatory (R00–R03, 785)
Cardiovascular	Template:Navbox subgroup
Myeloid/blood	Template:Navbox subgroup

v t e Symptoms and signs: respiratory system (R04–R07, 786)
Hemorrhage	Epistaxis Hemoptysis
Abnormalities of breathing	Respiratory sounds Stridor Wheeze Crackles Rhonchi Hamman's sign Apnea Dyspnea Hyperventilation/Hypoventilation Hyperpnea/Tachypnea/Hypopnea/Bradypnea Orthopnea/Platypnea Trepopnea Biot's respiration Cheyne-Stokes respiration Kussmaul breathing Hiccup Mouth breathing/Snoring Breath-holding
Other	Asphyxia Cough Pleurisy Sputum Respiratory arrest Hypercapnia/Hypocapnia Pectoriloquy: Whispered pectoriloquy Egophony Bronchophony Pleural friction rub Fremitus Silhouette sign
Chest, general	Chest pain Precordial catch syndrome

v t e Symptoms and signs: digestive system and abdomen (R10–R19, 787,789)
GI tract	Template:Navbox subgroup
Accessory	Hepatosplenomegaly/Hepatomegaly Jaundice
Abdominopelvic	Ascites
Abdominal – general	Abdominal pain (Acute abdomen, Colic, Baby colic) Splenomegaly Abdominal guarding · Abdominal mass · Rebound tenderness Shifting dullness · Bulging flanks · Puddle sign · Fluid wave test

v t e Symptoms and signs: Symptoms concerning nutrition, metabolism and development (R62–R64, 783)
Ingestion/Weight	decrease: Anorexia • Weight loss/Cachexia/Underweight increase: Polyphagia • Polydipsia • Orexigenia • Weight gain
Growth	Delayed milestone • Failure to thrive • Short stature (e.g., Idiopathic)

@@ Line 1: / Line 1: @@
+__NOTOC__
 '''For patient information, click [[Stupor (patient information)|here]]'''
-{{Infobox_Disease |
-  Name           = {{PAGENAME}} |
-  Image          = |
-  Caption        = |
-  DiseasesDB     = |
-  ICD10          = |
-  ICD9           = |
-  ICDO           = |
-  OMIM           = |
-  MedlinePlus    = |
-  eMedicineSubj  = |
-  eMedicineTopic = |
-  MeshID         = |
-}}
 {{Search infobox}}
 {{CMG}}
 ==Overview==
-'''Stupor''' is the lack of critical cognitive function and [[level of consciousness]] wherein a sufferer is almost entirely unresponsive and only responds to base stimuli such as pain. [[Akinesia|akinesis]] and [[Akinetic mutism|mutism]] are present but with relative preservation of conscious awareness.  A person is also rigid and mute and only appears to be conscious as the eyes are open and follow surrounding objects (Gelder, Mayou and Geddes 2005).
+'''Stupor''' is the lack of critical cognitive function and level of consciousness wherein a sufferer is almost entirely unresponsive and only responds to base stimuli such as pain. [[Akinesia|Akinesis]] and [[Akinetic mutism|mutism]] are present but with relative preservation of conscious awareness.  A person is also rigid and mute and only appears to be conscious as the eyes are open and follow surrounding objects (Gelder, Mayou and Geddes 2005).
 ==Historical Perspective==
-The word derives from the [[Latin]] ''stupure'', meaning insensible.<ref>Berrios G E (1981) Stupor: A Conceptual History. ''Psychological Medicine'' 11: 677-688</ref>
+The word derives from the [[Latin]] ''stupure'', meaning insensible.
-==Differential Diagnosis of Underlying Causes==
+==Causes==
-By organ system:
+===Causes by Organ System===
 {|style="width:75%; height:100px" border="1"
 |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
-|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Arrhythmias]] such as [[heart block]], [[Cardiogenic shock]], [[Congestive heart failure]], [[hypertensive crisis]], [[hypotension]]
+|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Arrhythmia]],  [[Basilar occlusion]],  [[Bilateral anterior cerebral artery occlusion]],  [[Bilateral internal carotid occlusion]],  [[Cardiac arrest]],  [[Cardiogenic shock]],  [[Cerebral vasculitis]],  [[Congestive heart failure]],  [[Disseminated intravascular coagulation]],  [[Fat embolism]],  [[Heart failure]],  [[Hypertensive crisis]],  [[Hypertensive encephalopathy]],  [[Hypotension]],  [[Massive or bilateral supratentorial infarction]],  [[Myocardial infarction]],  [[Nonbacterial thrombotic endocarditis ]],  [[Pontine hemorrhage]],  [[Sagittal sinus thrombosis]],  [[Stroke]],  [[Subacute bacterial endocarditis]],  [[Syncope]],  [[Thrombophlebitis]],  [[Vascular diseases]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Chemical / poisoning'''
-|bgcolor="Beige"| [[Alcohol abuse]], [[heavy metals]], [[hydrocarbons]]
+|bgcolor="Beige"| [[2-aminopyridine]],  [[3-aminopyridine ]],  [[Alcohol abuse ]],  [[Alicyclic hydrocarbons ]],  [[Alzheimer's disease]],  [[Amphetamines]],  [[Antifreeze ]],  [[Antipsychotics]],  [[Anxiolytics]],  [[Bottlebrush buckeye poisoning]],  [[California buckeye poisoning ]],  [[Carbon monoxide]],  [[Cologne ]],  [[Common poppy poisoning ]],  [[Cyanide]],  [[Cycad nut poisoning ]],  [[Deoderant ]],  [[Ethylene glycol]],  [[Hair bleach ]],  [[Hair dye ]],  [[Heavy metals]],  [[Hydrocarbons]],  [[Incense ]],  [[Lead]],  [[Mayapple poisoning ]],  [[Methanol]],  [[Milkweed poisoning ]],  [[Oil-based paint]],  [[Paraldehyde]],  [[Pergolide]],  [[Propylene glycol ]],  [[Red buckeye poisoning ]],  [[Sodium monofluoroacetate ]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Dermatologic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Heat stroke]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Drug Side Effect'''
-|bgcolor="Beige"| [[Anxiolytics]], [[antidepressants]], [[antipsychotics]], [[anticonvulsants]], [[LSD]], [[narcotics]], [[opiates]], [[sedatives]]
+|bgcolor="Beige"| [[Anticholinergics]],  [[Anticonvulsants]],  [[Antidepressants]],  [[Antipsychotics]],  [[Anxiolytics]],  [[Barbiturates]],  [[Bromides]],  [[Bromoform ]],  [[Depilatories ]],  [[Lithium]],  [[Lsd]],  [[Morphine overdose ]],  [[Nabilone]],  [[Narcotics]],  [[Opiates]],  [[Phencylidine]],  [[Psychotropics]],  [[Salicylate]],  [[Sedatives]],  [[Thallium]],  [[Tranquilizers]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 47: / Line 34: @@
 |-bgcolor="LightSteelBlue"
 | '''Endocrine'''
-|bgcolor="Beige"| [[Hyperglycemia]], [[hyperthyroidism]], [[hypoglycemia]], [[hypothyroidism]]
+|bgcolor="Beige"| [[Addisonian crisis]],  [[Aftershave ]],  [[Hyperparathyroidism ]],  [[Hyperthyroidism]],  [[Hypothyroidism]],  [[Pituitary apoplexy]],  [[Waterhouse-friderichsen syndrome]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 55: / Line 42: @@
 |-bgcolor="LightSteelBlue"
 | '''Gastroenterologic'''
-|bgcolor="Beige"| [[Liver failure]]
+|bgcolor="Beige"| [[Hepatic encephalopathy]],  [[Hereditary carnitine deficiency syndrome ]],  [[Liver encephalopathy ]],  [[Liver failure]],  [[Variant cjd ]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Genetic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Hallervorden-spatz disease ]],  [[Porphyria]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Hematologic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Aminoacidemia]],  [[Aneurysm]],  [[Brainstem hemorrhage]],  [[Brainstem infarction]],  [[Carnitine deficiency]],  [[Hypercalcemia]],  [[Hypercapnia]],  [[Hypercarbia]],  [[Hyperglycemia]],  [[Hyperglycerolemia]],  [[Hypergylcemic nonketotic coma]],  [[Hypermagnesemia]],  [[Hyperthermia]],  [[Hypocalcemia]],  [[Hypoglycemia]],  [[Hypothermia]],  [[Hypoxia]],  [[Intracerebral bleed]],  [[Lactic acidosis]],  [[Leukoencephalopathy]],  [[Monoamine oxidase inhibitors]],  [[Multifocal leukoencephalopathy]],  [[Respiratory acidosis ]],  [[Sepsis]],  [[Stroke]],  [[Subacute sclerosing leukoencephalitis]],  [[Subarachnoid hemorrhage]],  [[Subdural hemorrhage bilateral]],  [[Thalamic hemorrhage]],  [[Thrombotic thrombocytopenic purpura]],  [[Vitamin d deficiency]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Iatrogenic'''
-|bgcolor="Beige"| Overdose of [[anxiolytics]], [[antidepressants]], [[antipsychotics]], [[anticonvulsants]], [[narcotics]], [[opiates]], [[sedatives]]
+|bgcolor="Beige"| Overdose of [[anxiolytics]], [[antidepressants]], [[antipsychotics]], [[anticonvulsants]], [[narcotics]], [[opiates]], [[sedatives]], [[Dialysis encephalopathy]],
 |-
 |-bgcolor="LightSteelBlue"
 | '''Infectious Disease'''
-|bgcolor="Beige"| Infection involving the brain ([[brain abscess]], [[meningitis]]), an infection complicated by [[sepsis]]
+|bgcolor="Beige"| [[Bacterial meningitis]],  [[Bartonellosis ]],  [[Brain abscess]],  [[Cerebral abscess]],  [[Cerebral malaria]],  [[Herpes simplex encephalitis]],  [[Infectious disease]],  [[Malaria]],  [[Malignant buotonneuse fever ]],  [[Postinfectious encephalomyelitis]],  [[Rickettsial disease ]],  [[Serratia meningitis ]],  [[Subacute bacterial endocarditis]],  [[Subdural empyema]],  [[Syphilis]],  [[Typhoid fever]],  [[Typhus ]],  [[Variant cjd ]],  [[Viral encephalitis]],  [[Waterhouse-friderichsen syndrome]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 79: / Line 66: @@
 |-bgcolor="LightSteelBlue"
 | '''Neurologic'''
-|bgcolor="Beige"| [[Alzheimer's disease]], [[dementia]], Lesions of the [[Reticular activating system|Ascending Reticular Activation System]] on height of the [[pons]] and [[metencephalon]] have been shown to cause stupor. The incidence is higher after left-sided [[lesion]]s, [[seizure]], [[stroke]]
+|bgcolor="Beige"| [[Acute disseminated encephalomyelitis]],  [[Aneurysm]],  [[Apraxia]],  [[Bacterial meningitis]],  [[Benign astrocytoma ]],  [[Bilateral anterior cerebral artery occlusion]],  [[Brain abscess]],  [[Brain tumor]],  [[Brainstem hemorrhage]],  [[Brainstem infarction]],  [[Brainstem thrombencephalitis]],  [[Bristowe's syndrome ]],  [[Catatonia]],  [[Catatonic depression]],  [[Catatonic schizophrenia]],  [[Central pontine myelinolysis]],  [[Cerebral abscess]],  [[Cerebral malaria]],  [[Cerebral vasculitis]],  [[Coma]],  [[Concussion]],  [[Conversion disorder]],  [[Creutzfeldt-jakob disease]],  [[Dementia]],  [[Depression]],  [[Dialysis encephalopathy]],  [[Dysarthria]],  [[Exhaustion]],  [[Fainting]],  [[Fatal familial insomnia ]],  [[Gjessing's syndrome]],  [[Hallervorden-spatz disease ]],  [[Hereditary carnitine deficiency syndrome ]],  [[Herpes simplex encephalitis]],  [[Hydrocephalus]],  [[Hypertensive encephalopathy]],  [[Intracerebral bleed]],  [[Japanese encephalitis ]],  [[Listlessness]],  [[Liver encephalopathy ]],  [[Malaise]],  [[Marchiafava-bignami disease ]],  [[Massive or bilateral supratentorial infarction]],  [[Meningitis]],  [[Midline brainstem tumor]],  [[Multiple sclerosis]],  [[Neuroleptic malignant syndrome ]],  [[Nonconvulsive status epilepticus]],  [[Ophthalmoparesis]],  [[Postictal seizure]],  [[Postinfectious encephalomyelitis]],  [[Prostration]],  [[Psychotropics]],  [[Reye's encephalopathy]],  [[Seizure]],  [[Sensory ataxic neuropathy]],  [[Serratia cerebral abscess ]],  [[Serratia meningitis ]],  [[Subacute sclerosing leukoencephalitis]],  [[Subarachnoid hemorrhage]],  [[Subdural empyema]],  [[Subdural hemorrhage bilateral]],  [[Syncope]],  [[Thalamic hemorrhage]],  [[Trauma-contusion]],  [[Unilateral hemispheric mass]],  [[Viral encephalitis]],  [[Wernicke's encephalopathy]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Nutritional / Metabolic'''
-|bgcolor="Beige"| [[Vitamin D deficiency]]
+|bgcolor="Beige"| [[Diabetic ketoacidosis]],  [[Vitamin d deficiency]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 91: / Line 78: @@
 |-bgcolor="LightSteelBlue"
 | '''Oncologic'''
-|bgcolor="Beige"| [[Brain tumor]]
+|bgcolor="Beige"| [[Brain tumor]],  [[Bristowe's syndrome ]],  [[Midline brainstem tumor]],  [[Tumor ]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Opthalmologic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Lesions of the ascending reticular activation system ]],  [[Ophthalmoparesis]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Overdose / Toxicity'''
-|bgcolor="Beige"| [[Alcohol abuse]], [[narcotics]], [[opiates]], [[sedatives]]
+|bgcolor="Beige"| [[Alcohol abuse ]],  [[Amphetamines]],  [[Ativan overdose ]],  [[Barbiturates]],  [[California buckeye poisoning ]],  [[Darvocet overdose ]],  [[Dilaudid overdose ]],  [[Disulfiram toxicity ]],  [[Lsd]],  [[Morphine overdose ]],  [[Mushrooms]],  [[Opiates]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Psychiatric'''
-|bgcolor="Beige"| [[conversion disorder]], [[depression]], extreme [[fatigue]], [[schizophrenia]]
+|bgcolor="Beige"| [[Bell mania]],  [[Mental illness]],  [[Puerperal psychosis ]],  [[Schizophrenia]],  [[Severe depression]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 111: / Line 98: @@
 |-bgcolor="LightSteelBlue"
 | '''Renal / Electrolyte'''
-|bgcolor="Beige"| [[Hypercalcemia]], [[hyponatremia]], [[renal insufficiency]] (acute and chronic)
+|bgcolor="Beige"| [[Acid-base imbalance]],  [[Adrenal leukodystrophy]],  [[Diabetic ketoacidosis]],  [[Hypernatremia]],  [[Hyponatremia]],  [[Kidney failure]],  [[Renal insufficiency]],  [[Respiratory acidosis ]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 119: / Line 106: @@
 |-bgcolor="LightSteelBlue"
 | '''Sexual'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Syphilis]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Trauma'''
-|bgcolor="Beige"| [[Concussion]], [[heat stroke]], [[hypothermia]], [[near drowning]]
+|bgcolor="Beige"| [[Concussion]],  [[Heat stroke]],  [[Hyperthermia]],  [[Hypothermia]],  [[Near drowning]],  [[Trauma-contusion]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Urologic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Uremia]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 135: / Line 122: @@
 |}
-In alphabetical order:
+===Causes in Alphabetical Order===
-*[[Alcohol abuse]]
+{{columns-list|
+*[[2-aminopyridine]]
+*[[3-aminopyridine ]]
+*[[Acid-base imbalance]]
+*[[Acute disseminated encephalomyelitis]]
+*[[Addisonian crisis]]
+*[[Adrenal leukodystrophy]]
+*[[Aftershave ]]
+*[[Alcohol abuse ]]
+*[[Alicyclic hydrocarbons ]]
 *[[Alzheimer's disease]]
+*[[Aminoacidemia]]
+*[[Amphetamines]]
+*[[Aneurysm]]
+*[[Anticholinergics]]
 *[[Anticonvulsants]]
 *[[Antidepressants]]
+*[[Antifreeze ]]
 *[[Antipsychotics]]
 *[[Anxiolytics]]
-*[[Arrhythmias]] such as [[heart block]]
+*[[Apraxia]]
+*[[Arrhythmia]]
+*[[Ativan overdose ]]
+*[[Bacterial meningitis]]
+*[[Barbiturates]]
+*[[Bartonellosis ]]
+*[[Basilar occlusion]]
+*[[Bell mania]]
+*[[Benign astrocytoma ]]
+*[[Bilateral anterior cerebral artery occlusion]]
+*[[Bilateral internal carotid occlusion]]
+*[[Bottlebrush buckeye poisoning]]
 *[[Brain abscess]]
 *[[Brain tumor]]
+*[[Brainstem hemorrhage]]
+*[[Brainstem infarction]]
+*[[Brainstem thrombencephalitis]]
+*[[Bristowe's syndrome ]]
+*[[Bromides]]
+*[[Bromoform ]]
+*[[California buckeye poisoning ]]
+*[[Carbon monoxide]]
+*[[Cardiac arrest]]
 *[[Cardiogenic shock]]
+*[[Carnitine deficiency]]
+*[[Catatonia]]
+*[[Catatonic depression]]
+*[[Catatonic schizophrenia]]
+*[[Central pontine myelinolysis]]
+*[[Cerebral abscess]]
+*[[Cerebral malaria]]
+*[[Cerebral vasculitis]]
+*[[Cologne ]]
+*[[Coma]]
+*[[Common poppy poisoning ]]
+*[[Concussion]]
 *[[Congestive heart failure]]
 *[[Conversion disorder]]
-*[[COPD]]
+*[[Copd]]
+*[[Creutzfeldt-jakob disease]]
+*[[Cyanide]]
+*[[Cycad nut poisoning ]]
+*[[Darvocet overdose ]]
 *[[Dementia]]
-*[[Major depressive disorder|Depression]]
+*[[Deoderant ]]
+*[[Depilatories ]]
+*[[Depression]]
+*[[Diabetic ketoacidosis]]
+*[[Dialysis encephalopathy]]
+*[[Dilaudid overdose ]]
+*[[Disseminated intravascular coagulation]]
+*[[Disulfiram toxicity ]]
+*[[Dysarthria]]
+*[[Ethylene glycol]]
+*[[Exhaustion]]
+*[[Fainting]]
+*[[Fat embolism]]
+*[[Fatal familial insomnia ]]
+*[[Gjessing's syndrome]]
+*[[Hair bleach ]]
+*[[Hair dye ]]
+*[[Hallervorden-spatz disease ]]
+*[[Heart failure]]
 *[[Heat stroke]]
 *[[Heavy metals]]
+*[[Hepatic encephalopathy]]
+*[[Hereditary carnitine deficiency syndrome ]]
+*[[Herpes simplex encephalitis]]
 *[[Hydrocarbons]]
+*[[Hydrocephalus]]
 *[[Hypercalcemia]]
+*[[Hypercapnia]]
 *[[Hypercarbia]]
 *[[Hyperglycemia]]
+*[[Hyperglycerolemia]]
+*[[Hypergylcemic nonketotic coma]]
+*[[Hypermagnesemia]]
+*[[Hypernatremia]]
+*[[Hyperparathyroidism ]]
 *[[Hypertensive crisis]]
 *[[Hypertensive encephalopathy]]
+*[[Hyperthermia]]
 *[[Hyperthyroidism]]
+*[[Hypocalcemia]]
 *[[Hypoglycemia]]
 *[[Hyponatremia]]
@@ Line 166: / Line 233: @@
 *[[Hypothyroidism]]
 *[[Hypoxia]]
-*[[Infectious disease]]s, complicated by [[sepsis]]
+*[[Incense ]]
-*Lesions of the [[Reticular activating system|Ascending Reticular Activation System]] on height of the [[pons]] and [[metencephalon]] have been shown to cause stupor. The incidence is higher after left-sided [[lesion]]s.
+*[[Infectious disease]]
+*[[Intracerebral bleed]]
+*[[Japanese encephalitis ]]
+*[[Kidney failure]]
+*[[Lactic acidosis]]
+*[[Lead]]
+*[[Lesions of the ascending reticular activation system ]]
+*[[Leukoencephalopathy]]
+*[[Listlessness]]
+*[[Lithium]]
+*[[Liver encephalopathy ]]
 *[[Liver failure]]
-*[[LSD]]
+*[[Lsd]]
+*[[Malaise]]
+*[[Malaria]]
+*[[Malignant buotonneuse fever ]]
+*[[Marchiafava-bignami disease ]]
+*[[Massive or bilateral supratentorial infarction]]
+*[[Mayapple poisoning ]]
 *[[Meningitis]]
 *[[Mental illness]]
+*[[Methanol]]
+*[[Midline brainstem tumor]]
+*[[Milkweed poisoning ]]
+*[[Monoamine oxidase inhibitors]]
+*[[Morphine overdose ]]
+*[[Multifocal leukoencephalopathy]]
+*[[Multiple sclerosis]]
+*[[Mushrooms]]
+*[[Myocardial infarction]]
+*[[Nabilone]]
 *[[Narcotics]]
 *[[Near drowning]]
+*[[Neuroleptic malignant syndrome ]]
+*[[Nonbacterial thrombotic endocarditis ]]
+*[[Nonconvulsive status epilepticus]]
+*[[Oil-based paint]]
+*[[Ophthalmoparesis]]
 *[[Opiates]]
-*[[Renal insufficiency]]
+*[[Other hypnotics]]
+*[[Paraldehyde]]
+*[[Pergolide]]
+*[[Phencylidine]]
+*[[Pituitary apoplexy]]
+*[[Pontine hemorrhage]]
+*[[Porphyria]]
+*[[Postictal seizure]]
+*[[Postinfectious encephalomyelitis]]
+*[[Propylene glycol ]]
+*[[Prostration]]
+*[[Psychotropics]]
+*[[Puerperal psychosis ]]
+*[[Red buckeye poisoning ]]
+*[[Renal insufficiency]]
+*[[Respiratory acidosis ]]
+*[[Reye's encephalopathy]]
+*[[Rickettsial disease ]]
+*[[Sagittal sinus thrombosis]]
+*[[Salicylate]]
+*[[Schizophrenia]]
+*[[Sedatives]]
 *[[Seizure]]
-*[[Sedatives]]
+*[[Sensory ataxic neuropathy]]
-*[[Schizophrenia]]
+*[[Sepsis]]
+*[[Serratia cerebral abscess ]]
+*[[Serratia meningitis ]]
+*[[Severe depression]]
+*[[Sodium monofluoroacetate ]]
 *[[Stroke]]
-*[[Vitamin D deficiency]]
+*[[Subacute bacterial endocarditis]]
+*[[Subacute sclerosing leukoencephalitis]]
+*[[Subarachnoid hemorrhage]]
+*[[Subdural empyema]]
+*[[Subdural hemorrhage bilateral]]
+*[[Syncope]]
+*[[Syphilis]]
+*[[Thalamic hemorrhage]]
+*[[Thallium]]
+*[[Thrombophlebitis]]
+*[[Thrombotic thrombocytopenic purpura]]
+*[[Tranquilizers]]
+*[[Trauma-contusion]]
+*[[Tumor ]]
+*[[Typhoid fever]]
+*[[Typhus ]]
+*[[Unilateral hemispheric mass]]
+*[[Uremia]]
+*[[Variant cjd ]]
+*[[Vascular diseases]]
+*[[Viral encephalitis]]
+*[[Vitamin d deficiency]]
+*[[Waterhouse-friderichsen syndrome]]
+*[[Wernicke's encephalopathy]]
+}}
-==Differentiating stupor from other conditions==
+==Differentiating Stupor from other Diseases==
 Stupor is not the same thing as a [[coma]] or a [[vegetative state]]. For example, some people who become injured suddenly with a [[concussion]] or some other cognitive impairment resulting from injury enter a stupor, where they are partially aware of their surroundings, or they become unconscious until they are revived by themselves or by others. Stupor may be mistaken for [[delirium]] and may be treated with [[Haldol]] and / or other anti-psychotic drugs.
 ==Diagnosis==
-===Symptoms===
+===History and Symptoms===
-If not stimulated externally, a patient with stupor will be in a [[sleep]]y mode most of the time. In some extreme cases of severe depressive disorders the patient can become motionless, lose their appetite and become mute. Short periods of restricted [[responsivity]] can be achieved by intense [[stimulation]] (e.g. pain, bright light, loud noise).
+If not stimulated externally, a patient with stupor will be in a [[sleep]]y mode most of the time. In some extreme cases of severe depressive disorders the patient can become motionless, lose their appetite and become mute. Short periods of restricted [[responsivity]] can be achieved by intense stimulation (e.g. pain, bright light, loud noise).
-===CT Findings===
+Questions about the patients medical history and symptoms should include:
+*Time pattern
+**When did the decreased alertness happen?
+**How long did it last?
+**Has it ever happened before? If so, how many times?
+**Did the person behave the same way during past episodes?
+*Medical history
+**Does the person have epilepsy or a seizure disorder?
+**Does the person have diabetes?
+**Has the person been sleeping well?
+**Has there been a recent head injury?
+*Other
+**What medications does the person take?
+**Does the person use alcohol or drugs on a regular basis?
+**What other symptoms are present?
+===CT===
 Lesions of the [[Reticular activating system|Ascending Reticular Activation System]] on height of the [[pons]] and [[metencephalon]] have been shown to cause stupor. The incidence is higher after left-sided [[lesion]]s.
-==See also==
+==Treatment==
+Treatment depends on the cause of the decreased alertness. How well a person does depends on the cause of the condition.
+==Related Chapters==
 * [[Torpor]]
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 {{Symptoms and signs}}
-[[da:Stupor]]
-[[de:Stupor]]
 [[fr:État stuporeux]]
-[[it:Stupor]]
 [[ru:Сопор]]
-[[sr:Ступор]]
-[[sv:Stupor]]
 {{WikiDoc Help Menu}}
 {{WikiDoc Sources}}
 [[pl:Stupor]]
-[[Category:Symptoms]]
+[[Category:Medical signs]]
 [[Category:Signs and symptoms]]
 [[Category:Emergency medicine]]
 [[Category:Psychiatry]]
 [[Category:Neurology]]
-[[Category:Overview complete]]