MENTAL STATUS CHANGES AND STROKE

Objective: To determine the frequency with which an acute confusional state is caused by a stroke and to evaluate the usefulness of obtainin g computed tomography scans in this setting. Design: Retrospective ana lysis. Setting: Tertiary referral center. Patients: The authors review ed 127 neurology consultations requested for patients presenting with acute and apparently isolated mental status changes. The mean age was 62 years. Results: Nine (7%) of the 127 patients were thought to have suffered mental status changes as a result of an acute stroke: one sub arachnoid hemorrhage and eight ischemic strokes. There was no intracer ebral hemorrhage. The locations of the infarcts were: right frontopari etal (four patients), bilateral occipital (two patients), bilateral fr ontal (two patients), and right pontine (one patient, for whom the cau sality of the stroke was uncertain). Of those nine stroke patients pre senting with isolated mental symptoms, six (66%) had some focal abnorm ality on neurologic examination. Only three (2.7%) of the 109 patients with no focal findings were ultimately diagnosed as having strokes, a nd one of these had a subarachnoid hemorrhage. Conclusions: Stroke was a relatively rare cause of acute confusional syndrome. The neurologic examination had a very high negative predictive value (97%) and was r eliable in selecting patients who should undergo an imaging study.