Confusion physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Physical examination in cases of confusion helps in localizing the lesion if the cause is from the brain. It even gives clues to the underlying cause of the disease. Complete neurological examination may not be done due to limitation of patient's condition.

Physical examination

• Vital signs
  • Temperature : increase in temperature is significant for some infective foci.
  • Blood pressure : if decreased indicative of shock and hypoperfusion.
  • Pulse : if its increase it has to be correlated to raise in temperature.
  • Respiratory rate : there may be hyperventilation in few conditions due to anxiety, but in severe cases leading to coma respiratory rate may be compromised.

• General examination : A comprehensive examination may be tough due to altered mental status of the patient.
  • General behavior
  • Level of arousal
  • Alertness
  • Language or speech defects
  • Presence of agitation, restlessness, hyperactivity, anxiety

• Focused examination of Nervous system
  • Cranial nerve examination : this is limited by uncooperative patients. Funduscopic examination helps in checking for papilledema or hemorrhages. Checking for gag reflex to ensure safe oral feeds and medications.
  • Motor examination : underlying brain disease
  • Gait evaluation : check for cerebellar lesion

• Other signs suggesting underlying causes
  • Skull fracture - trauma
  • Neck stiffness - meningitis
  • Lip erosions - ingestion of poisons
  • Indwelling catheters - sepsis
  • Tongue bites - seizures
  • Neck swelling - thyroid disease
  • Signs of liver failure
  • Excessive sweating - dehydration, hypoglycemia