Paediatrics: Altered level of consciousness

Altered level of consciousness

The brain can be injured in many ways. Its responses to injury, however, are uniform and include any combination of:

• Altered level of consciousness (LOC).
• Seizures or dystonia.
• Impaired respiratory function.
• Loss of cardiovascular autoregulation.
• Cerebral swelling.
• SIADH.
• Weakness.

Take a note of:

• When symptoms started, and their progression (gradual versus sudden).
• Possible ingestion or exposure to medication or toxins.
• Possible recent trauma, illness, or exposure to infection.
• History: seizures; diabetes; allergies; chronic illness.
• Family history/consanguinity.
• Previous altered LOC.

Aetiology

Infectious causes

• Meningitis, encephalitis.
• Toxic shock.
• Subdural empyema, a cerebral abscess.

Autoimmune

Acute disseminated encephalomyelitis (ADEM).

Toxins 

See poisoning.

Neoplastic causes 

Brain tumours.

Trauma

• Head injury: concussion or contusion.
• Haemorrhage: epidural; subdural; brain.

Vascular causes

• AV malformation.
• Aneurysm, venous thrombosis.

Metabolic causes

• Hypoglycaemia.
• Diabetic ketoacidosis.
• Electrolyte abnormalities.
• Inborn errors of metabolism.
• Hepatic encephalopathy.
• Hormonal abnormalities: thyroid; adrenal; pituitary.
• Uraemic encephalopathy.

Other

• Hypothermia.
• Hyperthermia.
• Seizures and post-ictal state.
• Hypertension.
• Hydrocephalus.
• Hypoxia–ischaemia.
• Sepsis.
• Intussusception.