Stuporous; Mental status - decreased; Loss of alertness; Decreased consciousness; Changes in consciousness; Obtundation; Coma; Unresponsiveness
Decreased alertness is a state of reduced awareness.
A coma is a state of decreased alertness from which a patient cannot be awakened. A long-term coma is called a vegetative state.
Many conditions can cause decreased alertness, including:
Brain disorders or injury, such as:
Injury or accidents, such as:
Heart or breathing problems, such as:
Toxins and drugs, such as:
Get medical help for any decrease in consciousness, even when it is due to alcohol intoxication, fainting, or a seizure disorder that has already been diagnosed.
See the article on seizures for tips on how to care for a person who is having a seizure.
Persons with epilepsy or other seizure disorder should carry a Medic-Alert bracelet or pendant describing their condition. They should avoid situations that have triggered a seizure in the past.
Get medical help if someone has decreased alertness that cannot be explained. Call your local emergency number (such as 911) if normal alertness does not return quickly.
Most often, a person with decreased consciousness will be evaluated in an emergency room.
The doctor will perform a physical examination. The exam will include a detailed look at the heart, breathing, and nervous system.
The health care team will ask questions about the person's medical history and symptoms, including:
Tests that may be done include:
Treatment depends on the cause of the decreased alertness. How well a person does depends on the cause of the condition. The longer the person has had decreased alertness, the worse the outcome.
Blok BK, Newman TM. Syncope. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004:chap 52.
Huff JS. Altered mental status and coma. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004:chap 259.
Kirsch TD. Head injury. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004:chap 255.
Huff JS, Martin ML. Altered mental status and coma. In: Wolfson AB, Hendey GW, Ling LJ, et al, eds. Harwood-Nuss' Clinical Practice of Emergency Medicine. 5th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 14.
Lennihan L. Delirium and Confusion. In Rowland LP, Merritt HH, eds. Merritt's Neurology. 12th ed. Baltimore, Md: Lippincott Williams & Wilkins; 2009:chap 2.
Review Date: 4/5/2013
Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.
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