Altered mental status differential diagnosis: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
A lowered level of consciousness indicate a deficit in brain function. Level of consciousness can be lowered when the brain receives insufficient oxygen (as occurs in [[hypoxia (medical)|hypoxia]]); insufficient blood (as occurs in [[shock (circulatory)|shock]]); or has an alteration in the [[brain chemistry|brain's chemistry]].<ref name="Pollak02">{{cite book |author= Pollak AN, Gupton CL |title=Emergency Care and Transportation of the Sick and Injured |publisher=Jones and Bartlett |location=Boston |year=2002 |pages=140 |isbn=0-7637-1666-9 |oclc= |doi= |accessdate=2008-07-04 |url=http://books.google.com/?id=xAPuKkKA6FEC&pg=PT177&dq=%22level+of+consciousness%22}}</ref> [[Metabolic disorder]]s such as [[diabetes mellitus]] and [[uremia]] can alter consciousness. | A lowered level of consciousness indicate a deficit in brain function. Level of consciousness can be lowered when the brain receives insufficient oxygen (as occurs in [[hypoxia (medical)|hypoxia]]); insufficient blood (as occurs in [[shock (circulatory)|shock]]); or has an alteration in the [[brain chemistry|brain's chemistry]].<ref name="Pollak02">{{cite book |author= Pollak AN, Gupton CL |title=Emergency Care and Transportation of the Sick and Injured |publisher=Jones and Bartlett |location=Boston |year=2002 |pages=140 |isbn=0-7637-1666-9 |oclc= |doi= |accessdate=2008-07-04 |url=http://books.google.com/?id=xAPuKkKA6FEC&pg=PT177&dq=%22level+of+consciousness%22}}</ref> [[Metabolic disorder]]s such as [[diabetes mellitus]] and [[uremia]] can alter consciousness. [[hyponatremia|Hypo-]] or [[hypernatremia]] (decreased and elevated levels of [[sodium]], respectively) as well as [[dehydration]] can also produce an altered LOC.<ref name="Johnson98"> | ||
{{cite book |author=Johnson AF, Jacobson BH |title=Medical Speech-language Pathology: A Practitioner's Guide |publisher=Thieme |location=Stuttgart |year=1998 |pages=142 |isbn=0-86577-688-1 |oclc= |doi= |accessdate=2008-07-04 |url= http://books.google.com/?id=Vo5cPaOEG_4C&pg=PA142&vq=level+of+consciousness&dq=%22level+of+consciousness%22}}</ref> A [[pH]] outside of the range the brain can tolerate will also alter LOC.<ref name="Tindall90">{{cite book |author=Tindall SC |editor=Walker HK, Hall WD, Hurst JW |chapter= Level of consciousness |title= Clinical Methods: The History, Physical, and Laboratory Examinations|publisher=Butterworth Publishers |location=|year=1990 |pages= |isbn=|oclc=|doi= |accessdate=2008-07-04 |url= http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=cm&partid=380}}</ref> Exposure to [[drug]]s (e.g. [[alcohol]]) or [[toxin]]s may also lower LOC,<ref name="Pollak02"/> as may a [[core temperature]] that is too high or too low ([[hyperthermia]] or [[hypothermia]]). Increases in [[intracranial pressure]] (the pressure within the skull) can also cause altered LOC. It can result from [[traumatic brain injury]] such as [[concussion]]. | {{cite book |author=Johnson AF, Jacobson BH |title=Medical Speech-language Pathology: A Practitioner's Guide |publisher=Thieme |location=Stuttgart |year=1998 |pages=142 |isbn=0-86577-688-1 |oclc= |doi= |accessdate=2008-07-04 |url= http://books.google.com/?id=Vo5cPaOEG_4C&pg=PA142&vq=level+of+consciousness&dq=%22level+of+consciousness%22}}</ref> A [[pH]] outside of the range the brain can tolerate will also alter LOC.<ref name="Tindall90">{{cite book |author=Tindall SC |editor=Walker HK, Hall WD, Hurst JW |chapter= Level of consciousness |title= Clinical Methods: The History, Physical, and Laboratory Examinations|publisher=Butterworth Publishers |location=|year=1990 |pages= |isbn=|oclc=|doi= |accessdate=2008-07-04 |url= http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=cm&partid=380}}</ref> Exposure to [[drug]]s (e.g. [[alcohol]]) or [[toxin]]s may also lower LOC,<ref name="Pollak02"/> as may a [[core temperature]] that is too high or too low ([[hyperthermia]] or [[hypothermia]]). Increases in [[intracranial pressure]] (the pressure within the skull) can also cause altered LOC. It can result from [[traumatic brain injury]] such as [[concussion]]. [[Stroke]] and [[intracranial hemorrhage]] are other causes. [[Infection]]s of the [[central nervous system]] may also be associated with decreased LOC; for example, an altered LOC is the most common symptom of [[encephalitis]].<ref name="Scheld04"> | ||
{{cite book |author= Scheld WM, Whitley RJ, Marra CM |title=Infections of the Central Nervous System |publisher=Lippincott Williams & Wilkins |location=Hagerstown, MD |year=2004 |pages= 219|isbn=0-7817-4327-3 |oclc= |doi= |accessdate=2008-07-04 |url = http://books.google.com/?id=jjvFj6aQeMgC&pg=PA530&dq=%22level+of+consciousness%22#PPA530,M1}}</ref> [[Neoplasm]]s within the [[intracranial cavity]] can also affect consciousness, | {{cite book |author= Scheld WM, Whitley RJ, Marra CM |title=Infections of the Central Nervous System |publisher=Lippincott Williams & Wilkins |location=Hagerstown, MD |year=2004 |pages= 219|isbn=0-7817-4327-3 |oclc= |doi= |accessdate=2008-07-04 |url = http://books.google.com/?id=jjvFj6aQeMgC&pg=PA530&dq=%22level+of+consciousness%22#PPA530,M1}}</ref> [[Neoplasm]]s within the [[intracranial cavity]] can also affect consciousness, as can [[epilepsy]] and [[Postictal state|post-seizure state]]s.<ref name="Tindall90"/> A decreased LOC can also result from a combination of factors. | ||
A [[concussion]], which is a mild traumatic brain injury (MTBI) may result in decreased LOC. | A [[concussion]], which is a mild traumatic brain injury (MTBI) may result in decreased LOC. | ||
Revision as of 01:33, 25 February 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Pratik Bahekar, MBBS [2]
Overview
Differential Diagnosis
A lowered level of consciousness indicate a deficit in brain function. Level of consciousness can be lowered when the brain receives insufficient oxygen (as occurs in hypoxia); insufficient blood (as occurs in shock); or has an alteration in the brain's chemistry.[1] Metabolic disorders such as diabetes mellitus and uremia can alter consciousness. Hypo- or hypernatremia (decreased and elevated levels of sodium, respectively) as well as dehydration can also produce an altered LOC.[2] A pH outside of the range the brain can tolerate will also alter LOC.[3] Exposure to drugs (e.g. alcohol) or toxins may also lower LOC,[1] as may a core temperature that is too high or too low (hyperthermia or hypothermia). Increases in intracranial pressure (the pressure within the skull) can also cause altered LOC. It can result from traumatic brain injury such as concussion. Stroke and intracranial hemorrhage are other causes. Infections of the central nervous system may also be associated with decreased LOC; for example, an altered LOC is the most common symptom of encephalitis.[4] Neoplasms within the intracranial cavity can also affect consciousness, as can epilepsy and post-seizure states.[3] A decreased LOC can also result from a combination of factors. A concussion, which is a mild traumatic brain injury (MTBI) may result in decreased LOC.
References
- ↑ 1.0 1.1 Pollak AN, Gupton CL (2002). Emergency Care and Transportation of the Sick and Injured. Boston: Jones and Bartlett. p. 140. ISBN 0-7637-1666-9. Retrieved 2008-07-04.
- ↑ Johnson AF, Jacobson BH (1998). Medical Speech-language Pathology: A Practitioner's Guide. Stuttgart: Thieme. p. 142. ISBN 0-86577-688-1. Retrieved 2008-07-04.
- ↑ 3.0 3.1 Tindall SC (1990). "Level of consciousness". In Walker HK, Hall WD, Hurst JW. Clinical Methods: The History, Physical, and Laboratory Examinations. Butterworth Publishers. Retrieved 2008-07-04.
- ↑ Scheld WM, Whitley RJ, Marra CM (2004). Infections of the Central Nervous System. Hagerstown, MD: Lippincott Williams & Wilkins. p. 219. ISBN 0-7817-4327-3. Retrieved 2008-07-04.