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Mental Status Changes Differential  -  Outlines in Clinical Medicine on Physicians' Online 2001

A.  Overview of Causes

1.Mnemonic = "THERIPY"

2.Temperature, Toxin, Tumor, Trauma

3.Hydrocephalus (mass or pseudotumor), Hepatic Disease, Hypoxia

4.Hypertension or Hypotension

5.Electrolyte Abnormalities

• a.Hypercalcemia - increased Ca2+
• b.Hypernatremia - increased
• c.Hyponatremia - decreased Na+
• d.Hypoglycemia - decreased Glucose
• e.Hyperosmolar Coma (Hyperglycemia)

6.Encephalopathy

• a.Hepatic
• b.Thiamine Deficiency
• c.B12 Deficiency
• d.Thrombotic Thrombocytopenic Purpura (TTP; microangiopathic hemolytic anemia)

7.Renal Disease: Uremia

8.Infection

• a.meningitis
• b.encephalitis
• c.severe non-CNS infection of any type
• d.sepsis
• e.infectious mass

9.Psychiatric Disease

B.  Intracranial Mass and Altered Mental Status

1.Cerebrovascular

• a.Cavernous angioma
• b.Arteriovenous Malformation (AVM)
• c.Aneurysm
• d.Stroke (hemorrage)
• e.Hematoma

2.Infectious

• a.Viral - usually herpes simplex (usually encephalitis, but may have mass)
• b.Bacterial - syphilis, mycobacteria
• c.Fungal - cryptococcus, histoplasma, coccidiomycosis, blastomycosis
• d.Parasitic - toxoplasma, cysticercosis, echinococcus, schistosomiasis, amebiasis

3.Neoplasm

• a.Glioma and Glioblastoma
• b.Meningioma
• c.Lymphoma
• d.Metastases

4.Inflammatory Disorder

• a.Systemic Lupus Erythematosus (SLE)
• b.Behcet's Disease
• c.Sarcoidosis

5.Congenital Disorder

• a.Tuberous Sclerosis
• b.Neurofibromatosis (may have aneurysms)

References

1.Mitch WE and Goldberg AL. 1996. NEJM. 335(25):1897 (Case Report)

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