TOC  | D-Dx    

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

A. Overview of Causes -  Mnemonic = "THERIPY"         See outline "Confusion Differential"

1. Temperature, Toxin, Tumor, Trauma

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

3. Hypertension or Hypotension

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

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

6. Renal Disease: Uremia

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

8. Psychiatric Disease

B. Intracranial Mass and Altered Mental Status     See outline "Brain Tumors"

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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