Home > Disclaimer > Basic Oncology >Emergencies




Decreased Level of Consciousness


Reduced conscious level can be very mild (drowsy only) to a patient being unresponsive to pain and all stimuli.

First - assessment of:

  • Airway
  • Breathing
  • Circulation

Ensure stability

Second - Investigation:

  • History and physical (detailed neurological examination)
  • Blood work (including CBC, biochemical screen, clotting studies, blood cultures if febrile)
  • Emergent CT head if mass lesion suspected


The differential diagnosis of reduced levels of consciousness in a pediatric oncology patient:


Infection Viral encephalitis
Bacterial meningitis
Fungal meningitis or abscess
Septic shock & Disseminated Inravascular Coagulation
Non-Infectious leukoencephalopathy as a result of XRT and chemotherapy
Toxic Chemotherapy Methotrexate, Cytosine Arabinoside, Ifosphamide, 5-FU, Corticosteroids.
Supportive care drugs Benzodiazepines, Narcotics, Anticonvulsants.


  • Would be very unusual

Post RT somnolence syndrome

  • Usually causes drowsiness only
Trauma Head Injury Cerebrovascular bleed (low platelet count) and raised ICP
Vascular   Spontaneous cerebrovascular thrombosis or hemorrhage
Endocrine Diabetes hyper and hypoglycemia
Seizure   Post ictal state
Neoplastic Primary Primary CNS tumor and raised ICP
Secondary Metastatic disease to brain from another site
Tumor meningitis (leukemia most commonly)
Metabolic Organ failure Renal failure
Live failure
electrolyte/fluid imbalance due to disease or treatment SIADH and low serum Na
Low serum Magnesium
Systemic Low level oxygen to brain Hypoxia


Back to top