Acute changes in mental status can occur in any hospital setting. Clinicians are often at a loss to define accurately the course of a change in mental status, because of poor differentiation in the terminology surrounding this difficult diagnosis. A clear understanding the differences among several levels of altered mental status is needed to evaluate, accurately diagnose, and treat those patients with altered mental states. The differential diagnosis of altered mental status is diffuse and includes supratentorial mass lesions, infratentorial mass lesions, and metabolic disorders. Development of an individualized differential diagnosis and diagnostic approach for cases of altered mental status represents a challenge to all levels of clinicians

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