a. History: Headache, Preceding
Differential Diagnosis
Meningitis, Subarachnoid hemorrhage, Encephalitis.
Next Pivotal Assessment | Findings | ||
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2. **History Taking:**
- **History of Present Illness:** Determine the onset, duration, and progression of altered mental status. Ask about recent trauma, infections, substance use, or toxin exposure.
- **Past Medical History:** Document any history of neurological disorders, psychiatric conditions, diabetes, hypertension, or other chronic diseases.
- **Medications:** Review current medications for potential side effects or interactions.
- **Family and Social History:** Ask about family history of neurological or psychiatric conditions and recent social or environmental changes.
3. **Physical Examination:**
- **Neurological Examination:** Assess level of consciousness using the Glasgow Coma Scale (GCS). Examine cranial nerves, motor and sensory functions, reflexes, and coordination.
- **Head and Neck Examination:** Look for signs of trauma, meningismus (neck stiffness indicating possible meningitis), and other abnormalities.
- **Systemic Examination:** Conduct a general physical examination to identify signs of systemic illness or infection.
4. **Differential Diagnosis:**
- **Infections:** Meningitis, encephalitis, sepsis.
- **Vascular:** Stroke, transient ischemic attack (TIA), hypertensive encephalopathy.
- **Metabolic:** Hypoglycemia, hyperglycemia, electrolyte imbalances, liver or kidney failure.
- **Toxicologic:** Drug overdose, alcohol intoxication or withdrawal, toxin exposure.
- **Trauma:** Traumatic brain injury.
- **Psychiatric:** Acute psychosis, severe depression, delirium.
5. **Diagnostic Tests:**
- **Blood Tests:** Complete blood count (CBC), electrolytes, liver and kidney function tests, toxicology screen.
- **Imaging:** Computed tomography (CT) or magnetic resonance imaging (MRI) of the brain to identify structural abnormalities.
- **Lumbar Puncture:** If meningitis or encephalitis is suspected, perform a lumbar puncture to analyze cerebrospinal fluid (CSF).
- **Electroencephalography (EEG):** If seizure activity is suspected.
6. **Management:**
- **Treat Underlying Cause:** Based on the diagnosis, initiate appropriate treatment such as antibiotics for infections, medications for metabolic imbalances, or surgical interventions for trauma.
- **Supportive Care:** Maintain hydration, nutrition, and monitoring in a controlled environment.
This approach helps to systematically evaluate the patient and identify the cause of altered mental status, leading to appropriate treatment.