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Mental status changes and stroke

S R Benbadis1, C A Sila, R L Cristea

  • 1Department of Neurology, Cleveland Clinic Foundation, Ohio.

Journal of General Internal Medicine
|September 1, 1994
PubMed
Summary
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Stroke is a rare cause of acute confusional syndrome, accounting for only 7% of cases. A thorough neurologic examination is highly effective in ruling out stroke, with a 97% negative predictive value.

Area of Science:

  • Neurology
  • Neuroscience
  • Emergency Medicine

Background:

  • Acute confusional state (ACS) is a common presentation in clinical practice.
  • Determining the underlying etiology of ACS is crucial for timely and appropriate management.
  • Stroke is a potential, though often overlooked, cause of ACS.

Purpose of the Study:

  • To investigate the incidence of stroke as a cause of ACS.
  • To assess the diagnostic utility of computed tomography (CT) scans in patients with ACS.
  • To evaluate the role of neurologic examination in identifying stroke in ACS patients.

Main Methods:

  • Retrospective analysis of 127 neurology consultations for acute, isolated mental status changes.
  • Patients evaluated at a tertiary referral center.

Related Experiment Videos

  • Data collected on stroke diagnosis, location, and neurologic findings.

    • Main Results:

    • Stroke caused ACS in 7% of patients (9/127), including ischemic strokes and one subarachnoid hemorrhage.
    • Focal neurologic abnormalities were present in 66% of stroke patients with ACS.
    • Only 2.7% of patients without focal findings were diagnosed with stroke.

    Conclusions:

    • Stroke is an uncommon cause of acute confusional syndrome.
    • The neurologic examination demonstrates high negative predictive value (97%) for stroke in ACS.
    • Clinical assessment is reliable for guiding decisions on neuroimaging (CT scans).