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.


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


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