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- Jeffrey R. Avner, MD*
- *Professor of Clinical Pediatrics, Albert Einstein College of Medicine; Chief, Division of Pediatric Emergency Medicine, Children’s Hospital at Montefiore, Bronx, NY
Objectives
After completing this article, readers should be able to:
List the common causes of altered level of consciousness.
Discuss how to differentiate medical and structural causes of altered level of consciousness.
Develop a plan for the initial phase of evaluation for an altered level of consciousness.
Recognize the importance of radiologic imaging in a child who has an altered level of consciousness.
Know which ingestions are likely to cause neurologic adverse effects.
Definition
During the course of normal interaction with one another, we observe each other’s mannerisms, responses, movements, and communications. In a sense, a person’s behavior is determined by how he or she acts or reacts to internal and external stimuli. What is considered normal behavior is often age-specific and person-specific. For example, the response of a teenager to the early morning “buzz” of an alarm clock is usually a purposeful attempt to shut the alarm off; an infant may cry as a response to the same stimulus. Similarly, children who have certain chronic illnesses, such as static encephalopathy, may have blunted responses as a baseline behavior. Although major changes in behavior are readily apparent to any clinician, subtle changes often are appreciated best by parents and caretakers.
Essential to the evaluation of abnormalities in a child’s behavior is an understanding of levels of consciousness. Various terms that define specific conditions or alterations of normal levels of consciousness often are used interchangeably and incorrectly by clinicians and parents alike. Consciousness is a state of awareness of both one’s self and the environment. A child who has a normal level of consciousness can be awakened and is aware of what is happening to and around him- or herself. Alteration of the level of consciousness usually begins with reduced awareness of one’s self, followed by reduced awareness of the environment, and finally …
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