Initial evaluation of change in mental status

see Stepwise Evaluation of a Patient with Delirium

• History (witness & background crucial): tempo, premorbid sx (eg, focal neuro deficits, HA, infxn, pain, falls), medical conditions (eg, dementia, epilepsy, onc, cardiac, psych, infection/immune status), accompanied by head trauma, current meds (eg, sedatives, opioids, anticoag, anticonvulsants, immunosuppressants), drug/alcohol use
• General exam: VS, breathing pattern (eg, Cheyne-Stokes), tongue bite (seizure), nuchal rigidity (meningitis, SAH; do not test if c/f trauma/cervical spine fx), ecchymoses, rash, signs of head trauma (eg, Battle sign, raccoon eyes, hemotympanum, CSF rhinorrhea), asterixis, liver disease stigmata, embolic phenomena/endocarditis, s/s drug use
• Neuro exam