Checklist: Change in Mental Status After Neurosurgery

 

  • Assess consciousness/responsiveness
  • Assess ABCs, neurologic exam
  • If with focal deficits or signs of increased ICP – perform imaging (noncontrast CT, CTA?, MRI?)
  • Work-up:
    • ABG:  hypercapnea or hypoxia
    • Na, BUN/Crea, Glu, Ca, Mg, Phos
    • CSF studies / infectious work-up
    • EKG, cardiac enzymes
    • continuous EEG
  • withdrawal?  (review history – ETOH, benzodiazepine use)
  • medications?  (review med list – sedatives, analgesics, antipsychotics, anticholinergics)
  • residual effects of anesthesia?

Algorithm for evaluation of altered mental status after neurosurgeryCapture.JPG

 

*Residual anesthesia can temporarily unmask predisposition to focal deficit. If this is the case the focal neurologic change will improve with dissipation of anesthetic effects.

References

Bhardwaj, Anish, and Marek Alexander Z Mirski. Handbook Of Neurocritical Care. New York: Springer, 2010. Print.

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