Stroke's Impact: Altered Mental Status And Recovery

can stroke cause altered mental status

A stroke, also known as a cerebrovascular accident, can cause altered mental status. The brain controls our behaviour and emotions, so a stroke can lead to feelings of irritability, forgetfulness, carelessness, confusion, anger, anxiety, and depression. Altered mental status can manifest as confusion, amnesia, loss of alertness, disorientation, defects in judgment or thought, unusual behaviour, poor regulation of emotions, and disruptions in perception. The effects of a stroke can range from slight confusion to total disorientation and increased sleepiness, and in some cases, coma.

Characteristics Values
Type of stroke Ischemic stroke, Hemorrhagic stroke
Ischemic stroke cause Blockage from fatty build-up in the vessels or blockage from a clot
Hemorrhagic stroke cause A blood vessel in the brain leaking or rupturing
Symptoms Irritability, forgetfulness, carelessness, confusion, anger, anxiety, depression, hallucinations, delusions, apathy, neglect, aggression, emotional incontinence, catastrophic reactions, mood swings, PTSD, mania, obsessive thoughts, disorientation, loss of alertness, defects in judgment or thought, unusual or strange behavior, poor regulation of emotions, disruptions in perception, memory loss, inattention, weakness, numbness, pain, burning and tingling sensations, fatigue, paralysis, problems with balance or coordination, difficulty understanding speech, slurred speech, blurred vision, personality changes, cognitive impairment, dementia, psychosis
Elderly causes Stroke, infection, drug-drug interactions, or alterations in the living environment
AMS causes Hypoglycemia, intracranial hemorrhage, alcohol intoxication, meningitis, encephalitis, infection, trauma, metabolic changes, toxic ingestion, drugs and substance intoxication, metabolic endocrine abnormalities, cancer, system/organ dysfunction, acute alcoholism, adrenal dysfunction, seizure disorder, symptomatic arrhythmia, hypotension from GI bleeding or trauma
AMS diagnosis Delirium, coma, dementia
AMS treatment Benzodiazepines

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Ischemic strokes are the most common type, caused by a blockage from fatty build-up or a clot

A stroke can cause altered mental status, and ischemic strokes are the most common type of stroke, accounting for around 80% of all strokes. An ischemic stroke occurs when a vessel supplying blood to the brain is blocked, usually by a blood clot or a fatty deposit due to atherosclerosis. This blockage causes an inadequate supply of blood and oxygen to the brain, resulting in the death of brain tissue.

The main cause of ischemic strokes is atherosclerosis, which is the buildup of fatty deposits (plaques) along the walls of blood vessels. These fatty deposits can cause two types of obstructions: cerebral thrombosis and cerebral embolism. Cerebral thrombosis is the development of a blood clot at the site of a fatty plaque within a blood vessel supplying blood to the brain. Cerebral embolism occurs when a blood clot forms in another part of the body, such as the heart or large arteries in the upper chest or neck, and then travels to the brain, lodging in a blood vessel too small for it to pass through.

The urgent treatment for ischemic strokes is clot removal, which can be done through medication or mechanical treatments. Medications such as tissue plasminogen activator (tPA), also known as alteplase, can be administered through an IV to dissolve the clot and improve blood flow to the affected area of the brain. Mechanical treatments, such as mechanical thrombectomy, involve using a wire-cage device called a stent retriever to remove the clot.

Ischemic strokes typically result in sudden symptoms, including muscle weakness, paralysis, loss or abnormal sensation on one side of the body, difficulty speaking, confusion, problems with vision, dizziness, and loss of balance and coordination. These symptoms can vary depending on which artery is blocked and which part of the brain is affected.

The risk factors for ischemic strokes include high blood pressure, high cholesterol, coronary artery disease, insulin resistance, obesity, depression, and heart disorders. It is important to recognize the signs of a stroke and seek immediate medical attention to improve the chances of recovery and prevent permanent brain damage.

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Hemorrhagic strokes are less common, caused by a ruptured blood vessel bleeding into the brain

A stroke can cause altered mental status, and it impacts the brain and the functions it controls, such as behaviour, emotions, thinking, and memory. It can also affect perception and sensory functions like vision and hearing.

Hemorrhagic strokes, caused by ruptured blood vessels bleeding into the brain, are less common than ischemic strokes. They make up about 13% of stroke cases. Hemorrhagic strokes can be further classified into intracerebral hemorrhage (bleeding inside the brain) or subarachnoid hemorrhage (bleeding between the inner and outer layers of the tissue covering the brain, or between the brain and the membranes that cover it).

The symptoms of hemorrhagic strokes are similar to those of ischemic strokes and include:

  • Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
  • Sudden trouble speaking or understanding speech
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance, or coordination
  • Sudden severe headache with no known cause
  • Loss of consciousness
  • Paralysis of one side of the body
  • Sensitivity to light
  • Stiffness in the neck or neck pain
  • Fluctuations in heart rate and breathing
  • Difficulty swallowing
  • Abnormal taste in the mouth

The risk of permanent brain damage from a hemorrhagic stroke is 20% to 30%, and the risk of death is 10% to 15%. The chances of re-bleeding and subsequent brain damage increase with each episode of hemorrhagic stroke. Therefore, prompt medical attention is crucial to prevent life-threatening complications and more extensive brain damage.

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Altered mental status (AMS) is a symptom, not a disease, ranging from confusion to coma

Altered mental status (AMS) is not a disease but a symptom. It is a disruption in how the brain works that causes a change in behaviour. This change can happen suddenly or over a few days. AMS can range from slight confusion to total disorientation and increased sleepiness to a coma.

AMS can be caused by a stroke, which impacts the brain and its control over our behaviour and emotions. A stroke survivor may experience feelings of irritability, forgetfulness, carelessness, or confusion. They may also feel anger, anxiety, or depression. A stroke can change a person's thinking and memory and how they see, hear, and feel the world.

The most common type of stroke is the ischemic stroke, caused by a blockage from fatty buildup in the vessels or a clot that has formed. The less common type is the hemorrhagic stroke, where a blood vessel in the brain leaks or ruptures, causing bleeding into other areas of the brain.

The BE FAST assessment can be used to determine if an AMS patient is suffering from a stroke:

  • Balance: Does the patient have trouble maintaining their balance?
  • Eyes: Does the patient have blurred vision in one or both eyes?
  • Facial Drooping: Is there facial drooping on either side of the patient's face?
  • Arm Drift: Does one of the patient's arms appear weaker or drift when held out in front of them?
  • Speech: Is the patient unable to speak, or are they slurring their speech or saying random words?
  • Time: It is critical to note the time the patient was observed with any of the above symptoms and the time they were last seen normal.

It is important to note that AMS can also be caused by other factors such as infection, drug-drug interactions, or alterations in the living environment, especially in the elderly.

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AMS can be caused by anything from hypoglycemia to intracranial haemorrhage

Altered mental status (AMS) is a disruption in how the brain works, causing a change in behaviour. This change can happen suddenly or over days. AMS ranges from slight confusion to total disorientation and increased sleepiness to coma. AMS can be caused by anything from hypoglycaemia to intracranial haemorrhage.

Hypoglycaemia is often defined by a plasma glucose concentration below 70 mg/dL, but symptoms may not occur until plasma glucose concentrations drop below 55 mg/dL. Hypoglycaemia is most often seen in patients with diabetes and are undergoing pharmacological intervention. However, in patients without diabetes, hypoglycaemia is uncommon. When it occurs, there are a few major causes: pharmacological, alcohol, critical illness, counter-regulatory hormone deficiencies, and non-islet cell tumours.

Intracranial haemorrhage refers to any bleeding within the intracranial vault, including the brain parenchyma and surrounding meningeal spaces. Intracerebral haemorrhage, or ICH, is a devastating disease. The 30-day mortality rate ranges from 35% to 52% with only 20% of survivors expected to have full functional recovery at 6 months.

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Post-stroke, cognitive problems are usually worst in the first few months but can improve in the first three

A stroke can cause altered mental status, also known as mental status changes. This is a disruption in how the brain works that cause changes in behaviour, emotions and personality. The impact of a stroke on the brain can lead to feelings of irritability, forgetfulness, carelessness, anger, anxiety, depression and confusion.

Post-stroke, cognitive problems are usually the worst in the first few months. However, they can improve within the first three months as the brain is most active during this period, trying to repair itself. This is when the most rapid recovery usually occurs, but it can continue into the first and second year.

During the first few days after a stroke, the patient might feel very tired and need to rest and recover. The medical team will identify the type of stroke, its location, the amount of damage and its effects. They will also perform tests and blood work.

The two types of stroke are ischemic and hemorrhagic. Ischemic strokes are the most common, caused by a blockage from fatty buildup or a clot. Hemorrhagic strokes are less common and involve a blood vessel in the brain leaking or rupturing, causing bleeding into other areas of the brain.

The BE FAST assessment can help determine if a person is having a stroke:

  • Balance: trouble maintaining balance
  • Eyes: blurred vision
  • Facial Drooping: drooping on either side of the face
  • Arm Drift: weakness or drift in one arm
  • Speech: aphasia or slurred speech
  • Time: it is critical to note the time the symptoms are observed and the time the patient was last seen as normal

Frequently asked questions

Yes, a stroke impacts the brain, which controls our behaviour and emotions. An altered mental status refers to general changes in brain function, such as confusion, amnesia, loss of alertness, disorientation, defects in judgement or thought, unusual behaviour, poor regulation of emotions, and disruptions in perception.

Signs of altered mental status include confusion, memory loss, loss of alertness, disorientation, defects in judgement or thought, unusual behaviour, poor regulation of emotions, and disruptions in perception.

In infants and children, the most common causes of altered mental status include infection, trauma, metabolic changes, and toxic ingestion. Young adults most often present with altered mental status secondary to toxic ingestion or trauma. The elderly commonly present with altered mental status due to stroke, infection, drug-drug interactions, or alterations in the living environment.

Altered mental status (AMS) is a disruption in how your brain works that cause a change in behaviour. This change can happen suddenly or over days. AMS ranges from slight confusion to total disorientation and increased sleepiness to coma.

Yes, patients can be treated with benzodiazepines. A thorough history and physical examination are necessary to establish the cause of the altered mental state.

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