Altered Mental Status, Acute

Phillip Brottman, M.D.
Disclosures		The author has no relationships with commercial interests related to the content of the presentation.

Phillip Brottman, MD, is an emergency physician and former assistant professor in the University of Chicago's Department of Medicine. Topics in his lecture include descriptors such as sleep, lethargy, stupor, and coma in altered mental status

This lecture is a comprehensive and detailed review of common causes of altered mental status, including stroke, anoxia, and toxicity ... and their testing and treatment. The commonest cause is hypoglycemia. It is easily treated, and proper care of hypoglycemic patients can return them to a normal life. Dr. Brottman presents a five-letter mnemonic for other common causes of mental status change.

The author describes his own experience in gaining the trust of the noncomatose patient with altered mental status, which he recommends be adopted during the evaluation process. He stresses the importance of a detailed history that should also involve the patient's family, friends and co-workers. He feels that prose describing the patient's behavior and thought processes, including the Glasgow Coma Scale, is an effective determinant of altered mental status. The Glasgow Coma Scale is a 3-15-point scale that quickly points out the level of dysfunction based on verbal, motor, and optical responses. Another points system described is the Mini Mental Exam, more subtle than Glasgow, in which orientation, registration, attention, and recall are charted and illustrated. Treatment begins with the ABCs of airway, breathing, and circulation.

The lecture defines and differentiates between delirium and dementia, with clear illustrations of both, particularly, in the case of dementia and the presentation of Alzheimer's Disease.

Additional topics include descriptionsof how blunt head trauma manifests itself as epidural or subdural hematomas ... and the role of various forms of stroke in altered mental status.

The lecture concludes with a discussion of acute and subacute anoxia, and toxic and psychiatric causes of altered mental status ... and a helpful checklist for dealing with the patient with altered mental status.