Etiologies of Decreased Responsiveness
see: Differential Diagnosis of Delirium
1° Neurologic (usually with focal signs)
- Vasc: ischemic stroke/TIA, ICH, VST, PRES, vasculitis, pituitary apoplexy
- Seizure: postictal, status, nonconvulsive
- Infxn: meningitis, encephalitis, abscess
- Trauma: TBI, concussion, diffuse axonal injury
- ↑ intracranial pressure: mass, edema, hydrocephalus, herniation
- Autoimmune/paraneoplastic enceph.
- Neurodeg: late-stage (eg, Alzheimer’s) or rapidly progressive (eg, CJD)
Systemic (esp. in elderly or prior CNS injury)
- Cardiac: global ischemia, HoTN, HTN enceph
- Pulmonary: ↓ PaO2, ↑ PaCO2
- GI: liver failure, ↑ NH3
- Renal: uremia, dialysis, ↓ or ↑ Na, ↓ or ↑ Ca
- Heme: TTP/HUS, DIC, hyperviscosity
- Endo: ↓ glc, DKA/HHNS, hypothyr., Addisonian
- ID: pneumonia, UTI, endocarditis, sepsis
- Hypothermia & hyperthermia
- Meds: anticholin., anti-hist., psychotrop., digoxin
- Toxins/withdrawal: EtOH, sedative, opiate, CO
- Psychiatric: catatonia, serotonin synd., NMS