Stupor

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Stupor is the lack of critical cognitive function and level of consciousness wherein a sufferer is almost entirely unresponsive and only responds to base stimuli such as pain. Akinesis and mutism are present but with relative preservation of conscious awareness. A person is also rigid and mute and only appears to be conscious as the eyes are open and follow surrounding objects (Gelder, Mayou and Geddes 2005).

Historical Perspective

The word derives from the Latin stupure, meaning insensible.

Causes

Causes by Organ System

Cardiovascular Arrhythmia, Basilar occlusion, Bilateral anterior cerebral artery occlusion, Bilateral internal carotid occlusion, Cardiac arrest, Cardiogenic shock, Cerebral vasculitis, Congestive heart failure, Disseminated intravascular coagulation, Fat embolism, Heart failure, Hypertensive crisis, Hypertensive encephalopathy, Hypotension, Massive or bilateral supratentorial infarction, Myocardial infarction, Nonbacterial thrombotic endocarditis , Pontine hemorrhage, Sagittal sinus thrombosis, Stroke, Subacute bacterial endocarditis, Syncope, Thrombophlebitis, Vascular diseases
Chemical / poisoning 2-aminopyridine, 3-aminopyridine , Alcohol abuse , Alicyclic hydrocarbons , Alzheimer's disease, Amphetamines, Antifreeze , Antipsychotics, Anxiolytics, Bottlebrush buckeye poisoning, California buckeye poisoning , Carbon monoxide, Cologne , Common poppy poisoning , Cyanide, Cycad nut poisoning , Deoderant , Ethylene glycol, Hair bleach , Hair dye , Heavy metals, Hydrocarbons, Incense , Lead, Mayapple poisoning , Methanol, Milkweed poisoning , Oil-based paint, Paraldehyde, Pergolide, Propylene glycol , Red buckeye poisoning , Sodium monofluoroacetate 
Dermatologic Heat stroke
Drug Side Effect Anticholinergics, Anticonvulsants, Antidepressants, Antipsychotics, Anxiolytics, Barbiturates, Bromides, Bromoform , Depilatories , Lithium, Lsd, Morphine overdose , Nabilone, Narcotics, Opiates, Phencylidine, Psychotropics, Salicylate, Sedatives, Thallium, Tranquilizers
Ear Nose Throat No underlying causes
Endocrine Addisonian crisis, Aftershave , Hyperparathyroidism , Hyperthyroidism, Hypothyroidism, Pituitary apoplexy, Waterhouse-friderichsen syndrome
Environmental Heavy metals, hypothermia
Gastroenterologic Hepatic encephalopathy, Hereditary carnitine deficiency syndrome , Liver encephalopathy , Liver failure, Variant cjd 
Genetic Hallervorden-spatz disease , Porphyria
Hematologic Aminoacidemia, Aneurysm, Brainstem hemorrhage, Brainstem infarction, Carnitine deficiency, Hypercalcemia, Hypercapnia, Hypercarbia, Hyperglycemia, Hyperglycerolemia, Hypergylcemic nonketotic coma, Hypermagnesemia, Hyperthermia, Hypocalcemia, Hypoglycemia, Hypothermia, Hypoxia, Intracerebral bleed, Lactic acidosis, Leukoencephalopathy, Monoamine oxidase inhibitors, Multifocal leukoencephalopathy, Respiratory acidosis , Sepsis, Stroke, Subacute sclerosing leukoencephalitis, Subarachnoid hemorrhage, Subdural hemorrhage bilateral, Thalamic hemorrhage, Thrombotic thrombocytopenic purpura, Vitamin d deficiency
Iatrogenic Overdose of anxiolytics, antidepressants, antipsychotics, anticonvulsants, narcotics, opiates, sedatives, Dialysis encephalopathy,
Infectious Disease Bacterial meningitis, Bartonellosis , Brain abscess, Cerebral abscess, Cerebral malaria, Herpes simplex encephalitis, Infectious disease, Malaria, Malignant buotonneuse fever , Postinfectious encephalomyelitis, Rickettsial disease , Serratia meningitis , Subacute bacterial endocarditis, Subdural empyema, Syphilis, Typhoid fever, Typhus , Variant cjd , Viral encephalitis, Waterhouse-friderichsen syndrome
Musculoskeletal / Ortho No underlying causes
Neurologic Acute disseminated encephalomyelitis, Aneurysm, Apraxia, Bacterial meningitis, Benign astrocytoma , Bilateral anterior cerebral artery occlusion, Brain abscess, Brain tumor, Brainstem hemorrhage, Brainstem infarction, Brainstem thrombencephalitis, Bristowe's syndrome , Catatonia, Catatonic depression, Catatonic schizophrenia, Central pontine myelinolysis, Cerebral abscess, Cerebral malaria, Cerebral vasculitis, Coma, Concussion, Conversion disorder, Creutzfeldt-jakob disease, Dementia, Depression, Dialysis encephalopathy, Dysarthria, Exhaustion, Fainting, Fatal familial insomnia , Gjessing's syndrome, Hallervorden-spatz disease , Hereditary carnitine deficiency syndrome , Herpes simplex encephalitis, Hydrocephalus, Hypertensive encephalopathy, Intracerebral bleed, Japanese encephalitis , Listlessness, Liver encephalopathy , Malaise, Marchiafava-bignami disease , Massive or bilateral supratentorial infarction, Meningitis, Midline brainstem tumor, Multiple sclerosis, Neuroleptic malignant syndrome , Nonconvulsive status epilepticus, Ophthalmoparesis, Postictal seizure, Postinfectious encephalomyelitis, Prostration, Psychotropics, Reye's encephalopathy, Seizure, Sensory ataxic neuropathy, Serratia cerebral abscess , Serratia meningitis , Subacute sclerosing leukoencephalitis, Subarachnoid hemorrhage, Subdural empyema, Subdural hemorrhage bilateral, Syncope, Thalamic hemorrhage, Trauma-contusion, Unilateral hemispheric mass, Viral encephalitis, Wernicke's encephalopathy
Nutritional / Metabolic Diabetic ketoacidosis, Vitamin d deficiency
Obstetric/Gynecologic No underlying causes
Oncologic Brain tumor, Bristowe's syndrome , Midline brainstem tumor, Tumor
Opthalmologic Lesions of the ascending reticular activation system , Ophthalmoparesis
Overdose / Toxicity Alcohol abuse , Amphetamines, Ativan overdose , Barbiturates, California buckeye poisoning , Darvocet overdose , Dilaudid overdose , Disulfiram toxicity , Lsd, Morphine overdose , Mushrooms, Opiates
Psychiatric Bell mania, Mental illness, Puerperal psychosis , Schizophrenia, Severe depression
Pulmonary COPD, hypercarbia, hypoxia due to a wide variety of lung diseases,
Renal / Electrolyte Acid-base imbalance, Adrenal leukodystrophy, Diabetic ketoacidosis, Hypernatremia, Hyponatremia, Kidney failure, Renal insufficiency, Respiratory acidosis 
Rheum / Immune / Allergy No underlying causes
Sexual Syphilis
Trauma Concussion, Heat stroke, Hyperthermia, Hypothermia, Near drowning, Trauma-contusion
Urologic Uremia
Miscellaneous No underlying causes

Causes in Alphabetical Order

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Differentiating Stupor from other Diseases

Stupor is not the same thing as a coma or a vegetative state. For example, some people who become injured suddenly with a concussion or some other cognitive impairment resulting from injury enter a stupor, where they are partially aware of their surroundings, or they become unconscious until they are revived by themselves or by others. Stupor may be mistaken for delirium and may be treated with Haldol and / or other anti-psychotic drugs.

Diagnosis

History and Symptoms

If not stimulated externally, a patient with stupor will be in a sleepy mode most of the time. In some extreme cases of severe depressive disorders the patient can become motionless, lose their appetite and become mute. Short periods of restricted responsivity can be achieved by intense stimulation (e.g. pain, bright light, loud noise).

Questions about the patients medical history and symptoms should include:

  • Time pattern
    • When did the decreased alertness happen?
    • How long did it last?
    • Has it ever happened before? If so, how many times?
    • Did the person behave the same way during past episodes?
  • Medical history
    • Does the person have epilepsy or a seizure disorder?
    • Does the person have diabetes?
    • Has the person been sleeping well?
    • Has there been a recent head injury?
  • Other
    • What medications does the person take?
    • Does the person use alcohol or drugs on a regular basis?
    • What other symptoms are present?

CT

Lesions of the Ascending Reticular Activation System on height of the pons and metencephalon have been shown to cause stupor. The incidence is higher after left-sided lesions.

Treatment

Treatment depends on the cause of the decreased alertness. How well a person does depends on the cause of the condition.

Related Chapters

References


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