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:
Inflammatory |
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. | |
RT
|
Post RT somnolence syndrome
|
|
| 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) | ||
| Hyperleukocytosis | ||
| Metabolic | Organ failure | Renal failure |
| Live failure | ||
| electrolyte/fluid imbalance due to disease or treatment | SIADH and low serum Na | |
| Low serum Magnesium | ||
| Hypercalcemia | ||
| dehydration | ||
| Systemic | Low level oxygen to brain | Hypoxia |
| Hypotension |
