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 the 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