Smith Austin T, Han Jin H
Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
Semin Neurol. 2019 Feb;39(1):5-19. doi: 10.1055/s-0038-1677035. Epub 2019 Feb 11.
Altered mental status is an umbrella term that covers a broad spectrum of disease processes that vary greatly in chronicity and severity. Causes can be a primary neurologic insult or a result of a systemic illness resulting in end-organ dysfunction of the brain. Acute changes in mental status are more likely than chronic changes to be immediately life-threatening and are therefore the focus of this review. Given the potential time-sensitive nature, acute changes in mental status must be addressed immediately and with urgency. We recommend a primary survey followed by a secondary survey with special attention to immediate life-threatening reversible causes. We then recommend a systems-based approach searching for any other life-threatening or reversible causes. Because the differential for altered mental status is broad, a comprehensive emergency department evaluation including a detailed history and physical exam as well as laboratory and radiographic testing is needed.
精神状态改变是一个涵盖广泛疾病过程的统称，这些疾病过程在慢性程度和严重程度上差异很大。病因可能是原发性神经损伤，也可能是导致脑终末器官功能障碍的全身性疾病的结果。精神状态的急性变化比慢性变化更有可能立即危及生命，因此是本综述的重点。鉴于其潜在的时间敏感性，精神状态的急性变化必须立即且紧急地加以处理。我们建议先进行初级评估，然后进行次级评估，特别关注立即危及生命的可逆性病因。然后，我们建议采用基于系统的方法来查找任何其他危及生命或可逆性病因。由于精神状态改变的鉴别诊断范围广泛，因此需要在急诊科进行全面评估，包括详细的病史和体格检查以及实验室和影像学检查。
