Altered Mental Status

Causes of altered mental status include drug intoxication or withdrawal, stroke syndromes, hypoxia, delayed leukoencephalopathy, infectious diseases, mycotic aneurysms, and secondary trauma from either loss of consciousness and fall or drug-related violence. 24 CNS infections occur as primary infections, as embolic complications of distant infections (e.g., endocarditis), and as extensions of local vertebral osteomyelitis. Infections commonly seen in this population include epidural abscess, bacterial meningitis, fungal meningitis, and brain abscess. Bacterial meningitis is usually caused by meningococcus, pneumococcus, or Staphylococcus aureus spreading from a primary endocarditis. Patients also may develop mycotic aneurysms or meningitis due to coincident brain or epidural abscess or as an inflammatory response to microemboli and bacteremia from endocarditis. In addition, CNS infection may occur from opportunistic organisms in the patient with coincident HIV infection.

Stroke syndromes have been well-reported complications secondary to low-flow states during heroin intoxication, hypertensive hemorrhage from amphetamines, phencyclidine, or cocaine, and embolized vegetations from infectious endocarditis. Delayed leukoencephalopathies, both hypoxia-related and unrelated to hypoxia, have been reported in IVDUs but are rare.25

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