Investigating altered consciousness (summary)

Last revised by Daniel J Bell on 2 Apr 2018
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.

  • 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

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Cases and figures

  • Case 1: normal CT brain
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  • Case 2: MCA stroke
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  • Case 3: Alzheimer disease
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  • Case 4: multi-infarct dementia
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  • Case 5: subdural hematoma
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  • Case 6: major head trauma
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