Altered level of consciousness
The brain can be injured in many
ways. Its responses to injury, however, are uniform and include any combination
of:
·
Altered
level of consciousness (LOC).
·
Seizures
or dystonia.
·
Impaired
respiratory function.
·
Loss
of cardiovascular autoregulation.
·
Cerebral
swelling.
·
SIADH.
·
Weakness.
Take a note of:
·
When
symptoms started, and their progression (gradual versus sudden).
·
Possible
ingestion or exposure to medication or toxins.
·
Possible
recent trauma, illness, or exposure to infection.
·
History: seizures; diabetes; allergies;
chronic illness.
·
Family
history/consanguinity.
·
Previous
altered LOC.
·
Meningitis,
encephalitis.
·
Toxic
shock.
·
Subdural
empyema, cerebral abscess.
Acute disseminated
encephalomyelitis (ADEM).
See poisoning.
Brain tumours.
·
Head injury: concussion or contusion.
·
Haemorrhage: epidural; subdural; brain.
·
AV
malformation.
·
Aneurysm,
venous thrombosis.
·
Hypoglycaemia.
·
Diabetic
ketoacidosis.
·
Electrolyte
abnormalities.
·
Inborn
errors of metabolism.
·
Hepatic
encephalopathy.
·
Hormonal abnormalities: thyroid; adrenal; pituitary.
·
Uraemic
encephalopathy.
·Hypothermia.
·Hyperthermia.
·Seizures and post-ictal state.
·Hypertension.
·Hydrocephalus.
·Hypoxia–ischaemia.
·Sepsis.
·Intussusception.
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