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Disturbance of Consciousness: Causes, Symptoms & Treatment

A disturbance of consciousness describes an impairment of wakefulness or awareness. It can range from mild confusion to complete unconsciousness and always requires medical evaluation.

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Things worth knowing about "Disturbance of Consciousness"

A disturbance of consciousness describes an impairment of wakefulness or awareness. It can range from mild confusion to complete unconsciousness and always requires medical evaluation.

What Is a Disturbance of Consciousness?

A disturbance of consciousness is a clinically significant alteration in a person´s normal state of wakefulness and awareness. Consciousness encompasses the ability to perceive oneself, the surrounding environment, and time, as well as to respond appropriately to stimuli. When this ability is reduced or lost, a disturbance of consciousness is present. It may be transient or prolonged, mild or life-threatening, and always warrants prompt medical evaluation.

Types of Disturbance of Consciousness

Disturbances of consciousness are broadly divided into two main categories:

Quantitative Disturbances

In quantitative disturbances, the level of consciousness is reduced. The recognized stages are:

Somnolence: Abnormal drowsiness; the patient can still be roused by verbal stimulation.
Stupor: Deep impairment of consciousness; the patient responds only to strong painful stimuli.
Coma: Complete loss of consciousness with no response to external stimuli of any kind.

Qualitative Disturbances

In qualitative disturbances, the clarity or coherence of consciousness is altered without necessarily reducing wakefulness:

Confusion: Disorientation to person, place, or time.
Delirium: An acute confusional state characterized by agitation, hallucinations, and autonomic disturbances.
Twilight state: A narrowed state of consciousness with automatic behavior, often following epileptic seizures.
Amnesia: Memory loss as a partial feature of a disturbance of consciousness.

Causes

Disturbances of consciousness can arise from a wide range of medical conditions and external factors:

Neurological causes: Stroke, traumatic brain injury, epilepsy, brain tumors, meningitis, or encephalitis.
Internal medicine causes: Hypoglycemia, renal failure, hepatic failure, thyroid disorders, severe infections (sepsis).
Cardiovascular causes: Cardiac arrest, severe arrhythmias, circulatory failure.
Toxic causes: Poisoning from alcohol, drugs, medications, or other substances.
Psychiatric causes: Severe mental disorders such as dissociative states.
Metabolic causes: Electrolyte imbalances, hypoxia (oxygen deficiency), hypercapnia (excess carbon dioxide).

Symptoms

The symptoms of a disturbance of consciousness depend on the underlying cause and severity. Common signs include:

Slowed or absent response to verbal address or touch
Disorientation (to person, place, time, or situation)
Confused or incoherent speech, or complete silence
Hallucinations or delusions
Psychomotor agitation or complete immobility
Changes in pupil size or eye movement
Alterations in breathing or circulation

Diagnosis

Diagnosis is established clinically and through targeted investigations. Key steps include:

Glasgow Coma Scale (GCS): A standardized tool for assessing the level of consciousness based on eye opening, verbal response, and motor response.
History and collateral history: Information from family members or bystanders about the circumstances and pre-existing conditions.
Laboratory tests: Blood glucose, electrolytes, renal and liver function tests, full blood count, and toxicology screening.
Imaging: CT or MRI of the brain to detect hemorrhage, infarction, or tumors.
EEG (electroencephalogram): Measurement of brain activity, especially when an epileptic cause is suspected.
Lumbar puncture: Analysis of cerebrospinal fluid when meningitis or encephalitis is suspected.

Treatment

Treatment is always guided by the underlying cause and the severity of the disturbance. General measures include:

First aid and emergency care: Ensuring airway, breathing, and circulation (the ABC approach); placing an unconscious patient in the recovery position.
Causal treatment: For example, glucose administration for hypoglycemia, antibiotics for meningitis, thrombolysis or thrombectomy for stroke, or antidotes for poisoning.
Intensive care: Severe coma often requires intensive care monitoring and mechanical ventilation.
Neurological rehabilitation: Following the acute phase, targeted rehabilitation may be needed to help the patient regain lost function.

When to Seek Emergency Medical Help

Any sudden or rapidly worsening disturbance of consciousness is a medical emergency. Call the emergency services immediately (911 in the US, 112 in the EU) if a person:

suddenly becomes unresponsive,
appears confused and disoriented,
experiences uncontrolled convulsions (seizure),
loses consciousness following a fall or accident.

References

Ropper, A.H., Samuels, M.A., Klein, J.P. - Adams and Victor's Principles of Neurology. 11th edition, McGraw-Hill Education (2019).
Teasdale, G., Jennett, B. - Assessment of coma and impaired consciousness. A practical scale. The Lancet, 304(7872), 81-84 (1974). PubMed PMID: 4136544.
Stevens, R.D., Bhardwaj, A. - Approach to the comatose patient. Critical Care Medicine, 34(1), 31-41 (2006). PubMed PMID: 16374149.

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