Stupor

# Overview
Stupor is the lack of critical cognitive function and level of consciousness wherein a sufferer is almost entirely unresponsive and only responds to base stimuli such as pain. Akinesis and mutism are present but with relative preservation of conscious awareness.  A person is also rigid and mute and only appears to be conscious as the eyes are open and follow surrounding objects (Gelder, Mayou and Geddes 2005).

# Historical Perspective
The word derives from the Latin stupure, meaning insensible.

# Causes

## Causes by Organ System

## Causes in Alphabetical Order
- 2-aminopyridine
- 3-aminopyridine
- Acid-base imbalance
- Acute disseminated encephalomyelitis
- Addisonian crisis
- Adrenal leukodystrophy
- Aftershave
- Alcohol abuse
- Alicyclic hydrocarbons
- Alzheimer's disease
- Aminoacidemia
- Amphetamines
- Aneurysm
- Anticholinergics
- Anticonvulsants
- Antidepressants
- Antifreeze
- Antipsychotics
- Anxiolytics
- Apraxia
- Arrhythmia
- Ativan overdose
- Bacterial meningitis
- Barbiturates
- Bartonellosis
- Basilar occlusion
- Bell mania
- Benign astrocytoma
- Bilateral anterior cerebral artery occlusion
- Bilateral internal carotid occlusion
- Bottlebrush buckeye poisoning
- Brain abscess
- Brain tumor
- Brainstem hemorrhage
- Brainstem infarction
- Brainstem thrombencephalitis
- Bristowe's syndrome
- Bromides
- Bromoform
- California buckeye poisoning
- Carbon monoxide
- Cardiac arrest
- Cardiogenic shock
- Carnitine deficiency
- Catatonia
- Catatonic depression
- Catatonic schizophrenia
- Central pontine myelinolysis
- Cerebral abscess
- Cerebral malaria
- Cerebral vasculitis
- Cologne
- Coma
- Common poppy poisoning
- Concussion
- Congestive heart failure
- Conversion disorder
- Copd
- Creutzfeldt-jakob disease
- Cyanide
- Cycad nut poisoning
- Darvocet overdose
- Dementia
- Deoderant
- Depilatories
- Depression
- Diabetic ketoacidosis
- Dialysis encephalopathy
- Dilaudid overdose
- Disseminated intravascular coagulation
- Disulfiram toxicity
- Dysarthria
- Ethylene glycol
- Exhaustion
- Fainting
- Fat embolism
- Fatal familial insomnia
- Gjessing's syndrome
- Hair bleach
- Hair dye
- Hallervorden-spatz disease
- Heart failure
- Heat stroke
- Heavy metals
- Hepatic encephalopathy
- Hereditary carnitine deficiency syndrome
- Herpes simplex encephalitis
- Hydrocarbons
- Hydrocephalus
- Hypercalcemia
- Hypercapnia
- Hypercarbia
- Hyperglycemia
- Hyperglycerolemia
- Hypergylcemic nonketotic coma
- Hypermagnesemia
- Hypernatremia
- Hyperparathyroidism
- Hypertensive crisis
- Hypertensive encephalopathy
- Hyperthermia
- Hyperthyroidism
- Hypocalcemia
- Hypoglycemia
- Hyponatremia
- Hypotension
- Hypothermia
- Hypothyroidism
- Hypoxia
- Incense
- Infectious disease
- Intracerebral bleed
- Japanese encephalitis
- Kidney failure
- Lactic acidosis
- Lead
- Lesions of the ascending reticular activation system
- Leukoencephalopathy
- Listlessness
- Lithium
- Liver encephalopathy
- Liver failure
- Lsd
- Malaise
- Malaria
- Malignant buotonneuse fever
- Marchiafava-bignami disease
- Massive or bilateral supratentorial infarction
- Mayapple poisoning
- Meningitis
- Mental illness
- Methanol
- Midline brainstem tumor
- Milkweed poisoning
- Monoamine oxidase inhibitors
- Morphine overdose
- Multifocal leukoencephalopathy
- Multiple sclerosis
- Mushrooms
- Myocardial infarction
- Nabilone
- Narcotics
- Near drowning
- Neuroleptic malignant syndrome
- Nonbacterial thrombotic endocarditis
- Nonconvulsive status epilepticus
- Oil-based paint
- Ophthalmoparesis
- Opiates
- Other hypnotics
- Paraldehyde
- Pergolide
- Phencylidine
- Pituitary apoplexy
- Pontine hemorrhage
- Porphyria
- Postictal seizure
- Postinfectious encephalomyelitis
- Propylene glycol
- Prostration
- Psychotropics
- Puerperal psychosis
- Red buckeye poisoning
- Renal insufficiency
- Respiratory acidosis
- Reye's encephalopathy
- Rickettsial disease
- Sagittal sinus thrombosis
- Salicylate
- Schizophrenia
- Sedatives
- Seizure
- Sensory ataxic neuropathy
- Sepsis
- Serratia cerebral abscess
- Serratia meningitis
- Severe depression
- Sodium monofluoroacetate
- Stroke
- Subacute bacterial endocarditis
- Subacute sclerosing leukoencephalitis
- Subarachnoid hemorrhage
- Subdural empyema
- Subdural hemorrhage bilateral
- Syncope
- Syphilis
- Thalamic hemorrhage
- Thallium
- Thrombophlebitis
- Thrombotic thrombocytopenic purpura
- Tranquilizers
- Trauma-contusion
- Tumor
- Typhoid fever
- Typhus
- Unilateral hemispheric mass
- Uremia
- Variant cjd
- Vascular diseases
- Viral encephalitis
- Vitamin d deficiency
- Waterhouse-friderichsen syndrome
- Wernicke's encephalopathy

# Differentiating Stupor from other Diseases
Stupor is not the same thing as a coma or a vegetative state. For example, some people who become injured suddenly with a concussion or some other cognitive impairment resulting from injury enter a stupor, where they are partially aware of their surroundings, or they become unconscious until they are revived by themselves or by others. Stupor may be mistaken for delirium and may be treated with Haldol and / or other anti-psychotic drugs.

# Diagnosis

## History and Symptoms
If not stimulated externally, a patient with stupor will be in a sleepy mode most of the time. In some extreme cases of severe depressive disorders the patient can become motionless, lose their appetite and become mute. Short periods of restricted responsivity can be achieved by intense stimulation (e.g. pain, bright light, loud noise).
Questions about the patients medical history and symptoms should include:
- Time pattern
When did the decreased alertness happen?
How long did it last?
Has it ever happened before? If so, how many times?
Did the person behave the same way during past episodes?
- When did the decreased alertness happen?
- How long did it last?
- Has it ever happened before? If so, how many times?
- Did the person behave the same way during past episodes?
- Medical history
Does the person have epilepsy or a seizure disorder?
Does the person have diabetes?
Has the person been sleeping well?
Has there been a recent head injury?
- Does the person have epilepsy or a seizure disorder?
- Does the person have diabetes?
- Has the person been sleeping well?
- Has there been a recent head injury?
- Other
What medications does the person take?
Does the person use alcohol or drugs on a regular basis?
What other symptoms are present?
- What medications does the person take?
- Does the person use alcohol or drugs on a regular basis?
- What other symptoms are present?

## CT
Lesions of the Ascending Reticular Activation System on height of the pons and metencephalon have been shown to cause stupor. The incidence is higher after left-sided lesions.

# Treatment
Treatment depends on the cause of the decreased alertness. How well a person does depends on the cause of the condition.

# Related Chapters
- Torpor