Investigating altered consciousness (summary)

This is a basic article for medical students and other non-radiologists

Altered consciousness or confusion is a common reason for admission to hospital, and involvement of radiology ^1,2.

Although the most common reason for acute confusion is intoxication which will improve - when altered neurology is present or the changes persists, more serious reasons need investigated.

Reference article

This is a summary article; we do not have a more in-depth reference article.

Summary

• questions
  • any systemic cause for confusion?
    • sepsis, hypoglycemia and drug interactions
  • any direct causes?
    • trauma, pressure effects, infarction or infection
  • are there any focal signs?
  • is there any relevant medication history?
    • anticoagulants, alcohol, narcotics?
• investigations
  • CT head is the first line investigation, especially in the acute setting
    • 10% of patients will have a cause found ¹
  • MRI can be used, but usually only after CT
• making the request
  • what is the likely underlying cause of confusion?
  • what is the urgency of the study?
• common pathology
  • systemic infection (rarely cerebral)
  • dementia (Alzheimer/vascular)
  • stroke
  • subdural hemorrhage
  • space-occupying lesions, e.g. tumor, abscess

Teaching playlist

• altered consciousness playlist