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Altered mental status (AMS) is a nonspecific term that describes disorders of mental awareness ranging from confusion to coma. Implicit in its vagueness is a wide breath of differential diagnosis that must be considered by medical providers. Some patients may have congenital or acquired causes of baseline change of mental status from an expected "normal" range of human experience. This pathway does not include these patients, but rather patients who have an acute change in their baseline mental awareness.
The differential diagnosis of AMS is broad and complex. For the most part the history and physical should guide diagnostic workup of these patients. However, many of these patients present with an undifferentiated story that requires a large workup.
AMS may present without a clear source. In these situations a through history and physical examination should focus on identifying both the cause and progression of the altered level of consciousness. In a large majority of cases the inciting factor is evident from this aspect of the evaluation alone.
Herniation is a potentially devastating complication of neurologic injury/hydrocephalus and unless an early suspicion and quick action is taken may result in death or profound complications.
The primary goal in patients with increased ICP is to maintain Cerebral blood fow (CBF) as predicted by Ohm's law:
CBF = (CAP - JVP) ÷ CVR