Confusion physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

Overview

In cases of confusion, a physical examination helps in localizing the lesion if the cause is from the brain. It also gives clues to the underlying cause of the disease. A complete neurological examination may not be done due to a limitation of patient's condition.

Physical Examination

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

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.

Neurologic

• 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

• 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