The symptoms of ALC are varied. Initial signs of ALC can be as subtle as slurring words while talking, or as severe as death. ALC can present as any of the levels of consciousness, from confusion to stupor to coma.
Symptoms accompanying ALC provide clues to the underlying cause Table 01. For example, if a person with ALC also has a tongue that is bitten or scarred, a doctor would suspect that epilepsy is the underlying cause. Likewise, if the person with ALC also has neck stiffness, the doctor may suspect that meningitis is the cause.
Table 1. Possible Causes of ALC by Accompanying Symptom or Sign
System or region Symptom Possible cause(s) Vital signs Hypertension Cerebral hemorrhage, hypertensive encephalopathy, increased intracranial pressure, renal or endocrine disorder Hypotension Ethanol or sedative drug toxicity, blood loss, diabetic coma Hyperthermia Systemic infection, heat stroke, withdrawal from alcohol or drugs Hypothermia Ethanol or barbiturate toxicity, shock, extracellular fluid deficit Bradycardia Heart block, Stokes-Adams syndrome, increased intracranial pressure, hypothyroidism Tachycardia Arrhythmia associated hypoxemia; atrial fibrillation associated with cerebral embolism Breath Peculiar odor Alcohol ingestion, hepatic failure, ketoacidosis, or uremia Skin Jaundice Hepatic disorder Needle-tracks Drug overdose Rashes Infectious disease, drug reaction, autoimmune disease, pellagra, thrombotic thrombocytopenic purpura Pallor Hemorrhage (internal or external) Head Localized tenderness, hematoma, crepitus Skull fracture Hemorrhage from ears or nostrils; hematoma, tenderness, or crepitus over mastoid process Basilar skull fracture Face and conjunctiva hyperemic Alcohol intoxication Tongue bitten or scarred Epilepsy Neck Stiffness Suggests meningitis/encephalitis, trauma, or subarachnoid hemorrhage
Certain causes of ALC are more common in particular groups of individuals. Traumatic brain injury is the leading cause of death and disability in those under 45 years of age, while metabolic problems, which can also cause ALC, occur most often in middle-aged and older people.
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