Paediatrics: Altered level of consciousness

2021-03-10 12:00 AM

The brain can be injured in many ways.

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.