Neurology Made Simple : Assessment & Investigations of Confusion in Alcoholic / Other patients

 Assessment of Confusion in Alcoholic / Other patients

Evaluate the score using GCS : Glasgow Coma Scale

Evaluate the score using AMT : Abbreviated Mental  Test

An accurate history from the patient may be difficult so ensure a proper collateral history.

Examination

Does the patient smell of alcohol

Any presence of fetor hepaticus that occurs in Chronic Liver Disease ?

Presence of hepatic flap ?

Any signs of Chronic Liver Disease ?

What is the nutritional status of patient ? Mal-nourished ?

Wasted

Abdomen exam GIT Examination

Any Ascites ?

Look for presence of spider naevi and caput medusa

Any hepatomegaly or splenomegaly ?

Any pain in abdomen in ascetic patient which would be indicative of Spontaneos bacterial peritonitis.

These signs should be looked for to exclude hepatic encephalopathy.

Neurological Examination :

Look for any evidence of head injury bruising etc.

Examine pupil sizes.

Any inequality of pupils is suggestive of sub dural or extra dural haematoma.

Look for any abnormal eye movements : This maybe seen in Wernickes encephalopathy .

Eg there may be presence of vertical nystagmus , horizontal nystagmus and weakness of eye abduction.

Look for presence of ataxia which may be seen in Wernickes encephalopathy.

Investigations 

Finger prick testing of blood glucose to exclude hypoglycemia.

FBC / Full Blood Count 

Coagulation Screen

Electrolytes

Renal profile

Liver profile

Inflammatory markers ( CRP and ESR and White Cell counts )

Blood cultures and urine cultures in case of pyrexia

Chest X ray to look for any pneumonic consolidation or fractured ribs or pneumothorax.

In case of ascites : perform an ascetic tap to diagnose for spontaneous bacterial peritonitis.

ABGs / Arterial blood gases

CT scan of head

Serum amylase.