So what are the four most common causes
that we wanna make sure we’re thinking about?
So systemic disease that is affecting the central nervous system
and we talked about some of those already.
Infection is definitely one of them that can do that,
fever sometimes as well.
Primary intracranial disease,
a classic thing here is if someone has something called a hemorrhagic stroke
which is basically bleeding into the brain tissue itself.
Subarachnoid hemorrhage is another cause
that can potentially cause people to be altered or confused.
Exogenous toxins, those are substances that patients may ingest
whether they’re illicit substances like alcohol or benzodiazepines or opioids,
or medications that are prescribed also can sometimes cause patients
to have altered mental status.
And then, drug withdrawal states are very important to consider.
The classic drug withdrawals that will cause altered mental status
are alcohol withdrawal and benzodiazepine withdrawal.
And when we’re thinking about those,
those are gonna be reflected in the vital signs for patients.
So patients can have an elevated heart rate,
elevated blood pressure, and confusion.
Some patients may present with seizures as well,
that’s something definitely you wanna make sure you’re considering.
Sometimes again, that history can be challenging to get from a patient.
So the medical record or talking with a family member, or a friend,
or someone who knows the patient may benefit you.
When we’re thinking about patients who present confused,
it’s important to think about what doesn’t cause altered mental status.
So what are things that don’t cause confusion
or that we’re not necessarily talking about here?
Psychosis is one of them.
Psychosis is a disorder of reality testing or a thought disorder
and it’s primarily caused by underlying psychiatric illness.
So patients who have schizophrenia can present with psychosis.
There are also sometimes substances that can make patients
or cause patients to be psychotic
and if you are concerned that someone has those,
you can potentially send a toxicology screen to think about that.
Strokes and tumors are the other thing that rarely cause global cerebral dysfunction.
So rarely will they make a patient globally altered.
Patients who have strokes may present with weakness in a certain area of their body
but rarely does it cause overall confusion.
Things that may mimic confusion is if a patient is aphasic.
So if a patient is unable to speak and not able to communicate with you,
you can imagine that that patient may come across as confused.
The same thing goes for any kind of visual field abnormality.
If a patient isn’t able to move their eyes a certain way or look at you,
that also may mimic confusion.