Altered mental status pathophysiology
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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
Pathophysiology
Although the neural science behind alertness, wakefulness, and arousal are not fully known, the reticular formation is known to play a role in these.[1] The ascending reticular activating system is a postulated group of neural connections that receives sensory input and projects to the cerebral cortex through the midbrain and thalamus from the retucular formation.[1] Since this system is thought to modulate wakefulness and sleep, interference with it, such as injury, illness, or metabolic disturbances, could alter the level of consciousness.[1]
Normally, stupor and coma are produced by interference with the brain stem, such as can be caused by a lesion or indirect effects, such as brain herniation.[1] Mass lesions in the brain stem normally cause coma due to their effects on the reticular formation.[2] Mass lesions that occur above the tentorium cerebelli (pictured) normally do not significantly alter the level of consciousness unless they are very large or affect both cerebral hemispheres.[1]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Invalid
<ref>tag; no text was provided for refs namedTindall90 - ↑
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.
Mass lesions within the brainstem produce coma by virtue of direct effects on the reticular formation