Stupor

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Overview
Stupor is the lack of critical cognitive function and level of consciousness wherein a sufferer is almost entirely unresponsive and only responds to base stimuli such as pain. akinesis and mutism are present but with relative preservation of conscious awareness. A person is also rigid and mute and only appears to be conscious as the eyes are open and follow surrounding objects (Gelder, Mayou and Geddes 2005).

Historical Perspective
The word derives from the Latin stupure, meaning insensible.

Differential Diagnosis of Underlying Causes
By organ system:

In alphabetical order:
 * Alcohol abuse
 * Alzheimer's disease
 * Anticonvulsants
 * Antidepressants
 * Antipsychotics
 * Anxiolytics
 * Arrhythmias such as heart block
 * Brain abscess
 * Brain tumor
 * Cardiogenic shock
 * Concussion
 * Congestive heart failure
 * Conversion disorder
 * COPD
 * Dementia
 * Depression
 * Heat stroke
 * Heavy metals
 * Hydrocarbons
 * Hypercalcemia
 * Hypercarbia
 * Hyperglycemia
 * Hypertensive crisis
 * Hypertensive encephalopathy
 * Hyperthyroidism
 * Hypoglycemia
 * Hyponatremia
 * Hypotension
 * Hypothermia
 * Hypothyroidism
 * Hypoxia
 * Infectious diseases, complicated by sepsis
 * Lesions of the Ascending Reticular Activation System on height of the pons and metencephalon have been shown to cause stupor. The incidence is higher after left-sided lesions.
 * Liver failure
 * LSD
 * Meningitis
 * Mental illness
 * Narcotics
 * Near drowning
 * Opiates
 * Renal insufficiency
 * Seizure
 * Sedatives
 * Schizophrenia
 * Stroke
 * Vitamin D deficiency

Differentiating stupor from other conditions
Stupor is not the same thing as a coma or a vegetative state. For example, some people who become injured suddenly with a concussion or some other cognitive impairment resulting from injury enter a stupor, where they are partially aware of their surroundings, or they become unconscious until they are revived by themselves or by others. Stupor may be mistaken for delirium and may be treated with Haldol and / or other anti-psychotic drugs.

Symptoms
If not stimulated externally, a patient with stupor will be in a sleepy mode most of the time. In some extreme cases of severe depressive disorders the patient can become motionless, lose their appetite and become mute. Short periods of restricted responsivity can be achieved by intense stimulation (e.g. pain, bright light, loud noise).

Questions about the patients medical history and symptoms should include:


 * Time pattern
 * When did the decreased alertness happen?
 * How long did it last?
 * Has it ever happened before? If so, how many times?
 * Did the person behave the same way during past episodes?
 * Medical history
 * Does the person have epilepsy or a seizure disorder?
 * Does the person have diabetes?
 * Has the person been sleeping well?
 * Has there been a recent head injury?
 * Other
 * What medications does the person take?
 * Does the person use alcohol or drugs on a regular basis?
 * What other symptoms are present?

Laboratory Studies

 * Chest x-ray
 * Complete blood count or blood differential
 * CT scan or MRI of the head
 * Electrocardiogram (ECG)
 * Electroencephalogram (EEG)
 * Electrolyte panel
 * Toxicology panel
 * Urinalysis

CT Findings
Lesions of the Ascending Reticular Activation System on height of the pons and metencephalon have been shown to cause stupor. The incidence is higher after left-sided lesions.

Treatment options
Treatment depends on the cause of the decreased alertness. How well a person does depends on the cause of the condition.