Confusion physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

In cases of confusion, a physical examination helps in localizing the lesion if the cause is from the brain. It also gives clues to the underlying cause of the disease. A complete neurological examination may not be done due to a limitation of the patient’s condition.

A comprehensive examination may be tough due to an altered mental status of the patient.

• Alertness
• General behavior
• Language or speech defects
• Level of arousal
• Presence of agitation, restlessness, hyperactivity, anxiety

• Temperature: An increase in temperature is significant for some infective foci.
• Blood pressure: If the blood pressure is decreased, it can be indicative of shock and hypoperfusion.
• Pulse: If the pulse is increased, it may be correlated to a raise in temperature.
• Respiratory rate: There may be hyperventilation in a few conditions due to anxiety, but in severe cases leading to a coma, the respiratory rate may be compromised.

• Cranial nerve examination : This is limited by uncooperative patients. Funduscopic examination helps in checking for papilledema or hemorrhages. Checking for a gag reflex to ensure safe oral feeds and medications.
• Motor examination : This can help in diagnosing an underlying brain disease.
• Gait evaluation : This can be used to check for a cerebellar lesion.

• Skull fracture – Trauma
• Neck stiffness – Meningitis
• Lip erosions – Ingestion of poisons
• Indwelling catheters – Sepsis
• Tongue bites – Seizures
• Neck swelling – Thyroid disease
• Signs of liver failure
• Excessive sweating – Dehydration, hypoglycemia

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