Altered mental status is an umbrella term that covers a broad spectrum of disease
processes that vary greatly in chronicity and severity. Causes can be a primary neurologic
insult or a result of a systemic illness resulting in end-organ dysfunction of the
brain. Acute changes in mental status are more likely than chronic changes to be immediately
life-threatening and are therefore the focus of this review. Given the potential time-sensitive
nature, acute changes in mental status must be addressed immediately and with urgency.
We recommend a primary survey followed by a secondary survey with special attention
to immediate life-threatening reversible causes. We then recommend a systems-based
approach searching for any other life-threatening or reversible causes. Because the
differential for altered mental status is broad, a comprehensive emergency department
evaluation including a detailed history and physical exam as well as laboratory and
radiographic testing is needed.
Keywords
altered mental status - confusion - altered behavior - generalized weakness - lethargy
- agitation - psychosis - disorientation - inappropriate behavior - hallucination
