A. Overview of Causes
- Mnemonic = "THERIPY"
- Temperature, Toxin, Tumor, Trauma
- Hydrocephalus (mass or pseudotumor), Hepatic Disease, Hypoxia
- Hypertension or Hypotension
- Electrolyte Abnormalities
- Hypercalcemia - increased Ca2+
- Hypernatremia - increased
- Hyponatremia - decreased Na+
- Hypoglycemia - decreased Glucose
- Hyperosmolar Coma (Hyperglycemia)
- Encephalopathy
- Hepatic
- Thiamine Deficiency
- B12 Deficiency
- Thrombotic Thrombocytopenic Purpura (TTP; microangiopathic hemolytic anemia)
- Renal Disease: Uremia
- Infection
- meningitis
- encephalitis
- severe non-CNS infection of any type
- sepsis
- infectious mass
- Psychiatric Disease
B. Intracranial Mass and Altered Mental Status [1]
- Cerebrovascular
- Cavernous angioma
- Arteriovenous Malformation (AVM)
- Aneurysm
- Stroke (hemorrage)
- Hematoma
- Infectious
- Viral - usually herpes simplex (usually encephalitis, but may have mass)
- Bacterial - syphilis, mycobacteria
- Fungal - cryptococcus, histoplasma, coccidiomycosis, blastomycosis
- Parasitic - toxoplasma, cysticercosis, echinococcus, schistosomiasis, amebiasis
- Neoplasm
- Glioma and Glioblastoma
- Meningioma
- Lymphoma
- Metastases
- Inflammatory Disorder
- Systemic Lupus Erythematosus (SLE)
- Behcet's Disease
- Sarcoidosis
- Congenital Disorder
- Tuberous Sclerosis
- Neurofibromatosis (may have aneurysms)
References
- Mitch WE and Goldberg AL. 1996. NEJM. 335(25):1897 (Case Report)