II. Causes: Pitfalls - critical diagnoses that are easily missed

III. Causes: Mnemonics

  1. Mnemonic: AEIOU TIPS
    1. Alcohol (or toxic Alcohols) or Abdominal Aortic Aneurysm
    2. Epilepsy (Status Epilepticus), Electrolytes, Hepatic Encephalopathy (or PRESS), endocrine problems
    3. Insulin (Hypoglycemia), Intussusception or Inborn Errors of Metabolism
    4. Opiates or Overdose
    5. Uremia
    6. Trauma (Closed Head Injury), Temperature (Hypothermia, hyperthermia), or Toxemia, Brain Tumor
    7. Infections (Sepsis, Meningitis, Encephalitis)
    8. Psychogenic, Pulmonary Embolism, Poisoning (Toxin Ingestion)
    9. Space occupying lesions, Stroke (including Intracranial Pressure), Shock, Seizure, shunt (ventriculoperitoneal)
  2. Mnemonic: I WATCH DEATH
    1. Infection
    2. Withdrawal
    3. Acute metabolic causes
    4. Trauma
    5. CNS Causes
    6. Hypoxia
    7. Deficiencies (Nutritional)
    8. Endocrinopathies (Adrenal Insufficiency, Myxedema, Hyperthyroidism)
    9. Acute Vascular Causes
    10. Toxins or Drugs
    11. Heavy Metals
  3. Mnemonic: SMASHED
    1. Sepsis or Substrates (abnormal Glucose, Thiamine deficiency)
    2. Meningitis or Mental Illness (acute Psychosis)
    3. Accident (Head Trauma, CVA) or Alcohol Intoxication or withdrawal
    4. Seizing or Stimulants
    5. Hypertension, Hyperthyroidism, Hypercarbia or Hypotension, Hypothyroidism, Hypoxia
    6. Electrolytes (Sodium, Hypercalcemia) or Encephalopathy
    7. Drugs (Drug Withdrawal, Carbon Monoxide, Lithium, steroids, Salicylates...)

V. Causes: Neurologic - Infratentorial

  1. Basilar Artery Occlusion
  2. Brainstem tumor
  3. Cerebellar Hemorrhage
  4. Pontine Hemorrhage
  5. Traumatic posterior fossa Hemorrhage

VII. Causes: Cardiopulmonary

VIII. Causes: Gastrointestinal and Renal

  1. Hepatic Encephalopathy
  2. Wernicke's Encephalopathy
  3. Uremic encephalopathy
  4. Peritonitis

XIII. References

  1. Herbert et al. in Herbert (2014) EM:Rap 14(11): 10-12
  2. Veauthier (2021) Am Fam Physician 104(5): 461-70 [PubMed]

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