Stupor: Difference between revisions

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__NOTOC__
'''For patient information, click [[Stupor (patient information)|here]]'''
'''For patient information, click [[Stupor (patient information)|here]]'''
{{Infobox_Disease |
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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.<ref>Berrios G E (1981) Stupor: A Conceptual History. ''Psychological Medicine'' 11: 677-688</ref>


==Differential Diagnosis of Underlying Causes==
==Causes==
By organ system:
===Causes by Organ System===
{|style="width:75%; height:100px" border="1"
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|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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===Causes in Alphabetical Order===
In alphabetical order:
*[[Alcohol abuse]]
*[[Alcohol abuse]]
*[[Alzheimer's disease]]
*[[Alzheimer's disease]]
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*[[Vitamin D deficiency]]
*[[Vitamin D deficiency]]


==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.
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==
==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).


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**Does the person use alcohol or drugs on a regular basis?
**Does the person use alcohol or drugs on a regular basis?
**What other symptoms are present?
**What other symptoms are present?
 
===CT===
===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 [[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.
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.


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


==See also==
==Related Chapters==
* [[Torpor]]
* [[Torpor]]


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[[Category:Psychiatry]]
[[Category:Psychiatry]]
[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Overview complete]]

Revision as of 20:18, 31 January 2013

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.[1]

Causes

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

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

References

  1. ↑ Berrios G E (1981) Stupor: A Conceptual History. Psychological Medicine 11: 677-688

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