Stupor

For patient information, click here

Stupor

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.

Differential Diagnosis of Underlying Causes

By organ system:

Cardiovascular	Arrhythmias such as heart block, Cardiogenic shock, Congestive heart failure, hypertensive crisis, hypotension
Chemical / poisoning	Alcohol abuse, heavy metals, hydrocarbons
Dermatologic	No underlying causes
Drug Side Effect	Anxiolytics, antidepressants, antipsychotics, anticonvulsants, LSD, narcotics, opiates, sedatives
Ear Nose Throat	No underlying causes
Endocrine	Hyperglycemia, hyperthyroidism, hypoglycemia, hypothyroidism
Environmental	Heavy metals, hypothermia
Gastroenterologic	Liver failure
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	Overdose of anxiolytics, antidepressants, antipsychotics, anticonvulsants, narcotics, opiates, sedatives
Infectious Disease	Infection involving the brain (brain abscess, meningitis), an infection complicated by sepsis
Musculoskeletal / Ortho	No underlying causes
Neurologic	Alzheimer's disease, dementia, 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, seizure, stroke
Nutritional / Metabolic	Vitamin D deficiency
Obstetric/Gynecologic	No underlying causes
Oncologic	Brain tumor
Opthalmologic	No underlying causes
Overdose / Toxicity	Alcohol abuse, narcotics, opiates, sedatives
Psychiatric	conversion disorder, depression, extreme fatigue, schizophrenia
Pulmonary	COPD, hypercarbia, hypoxia due to a wide variety of lung diseases,
Renal / Electrolyte	Hypercalcemia, hyponatremia, renal insufficiency (acute and chronic)
Rheum / Immune / Allergy	No underlying causes
Sexual	No underlying causes
Trauma	Concussion, heat stroke, hypothermia, near drowning
Urologic	No underlying causes
Miscellaneous	No underlying causes

In alphabetical order:

• Alcohol abuse
• Alzheimer's disease
• Anticonvulsants
• Antidepressants
• Antipsychotics
• Anxiolytics
• Arrhythmias such as heart block
• Brain abscess
• Brain tumor
• Cardiogenic shock
• Concussion
• Congestive heart failure
• Conversion disorder
• COPD
• Dementia
• Depression
• Heat stroke
• Heavy metals
• Hydrocarbons
• Hypercalcemia
• Hypercarbia
• Hyperglycemia
• Hypertensive crisis
• Hypertensive encephalopathy
• Hyperthyroidism
• Hypoglycemia
• Hyponatremia
• Hypotension
• Hypothermia
• Hypothyroidism
• Hypoxia
• Infectious diseases, complicated by sepsis
• 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.
• Liver failure
• LSD
• Meningitis
• Mental illness
• Narcotics
• Near drowning
• Opiates
• Renal insufficiency
• Seizure
• Sedatives
• Schizophrenia
• Stroke
• Vitamin D deficiency

Differentiating stupor from other conditions

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

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).

Most often, a person with decreased consciousness will be evaluated in an emergency room.

The doctor will perform a physical examination. The exam will include a detailed look at the heart, breathing, and nervous system.

The health care team will ask questions about the person's medical history and symptoms, including

• 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?

Laboratory Studies

• Chest x-ray
• Complete blood count or blood differential
• CT scan or MRI of the head
• Electrocardiogram (ECG)
• Electroencephalogram (EEG)
• Electrolyte panel
• Toxicology panel
• Urinalysis

CT Findings

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 options

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

See also

• Torpor