Stuporous; Mental status - decreased; Loss of alertness; Decreased consciousness; Changes in consciousness; Obtundation; Coma; Unresponsiveness
Decreased alertness is a state of reduced awareness.
A coma is a state of decreased alertness from which a person cannot be awakened. A long-term coma is called a vegetative state.
Many conditions can cause decreased alertness, including:
Brain disorders or injury, such as:
Injury or accidents, such as:
Heart or breathing problems, such as:
Toxins and drugs, such as:
See the article on seizures for tips on how to care for a person who is having a seizure.
People with epilepsy or other seizure disorders should wear a medical ID bracelet or necklace describing their condition. They should avoid situations that have triggered a seizure in the past.
Get medical help if someone has decreased alertness that cannot be explained. Call your local emergency number (such as 911) if normal alertness does not return quickly.
Most often, a person with decreased consciousness will be evaluated in an emergency room.
The health care provider will perform a physical examination. The exam will include a detailed look at the heart, breathing, and nervous system.
The health care team will ask questions about the person's medical history and symptoms, including:
Tests that may be done include:
Treatment depends on the cause of the decreased alertness. How well a person does depends on the cause of the condition.
The longer the person has had decreased alertness, the worse the outcome.
Bassin BS, Cooke JL. Depressed consciousness and coma. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 16.
Bassin BS, Cooke JL, Barsan WG. Altered mental status and coma. In: Adams JG, ed. Emergency Medicine: Clinical Essentials. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 94.
Lank PM, Kusin S. Ethanol and opioid intoxication and withdrawal. In: Adams JG, ed. Emergency Medicine: Clinical Essentials. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 154.
Lennihan L. Delirium and Confusion. In: Rowland LP, Pedley TA, eds. Merritt's Neurology. 12th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:chap 2.
MacNeill EM, Vashist S. Approach to syncope and altered mental status. Ped Clin N Am. 2013;60(5):1083-1106.
Last reviewed on: 6/1/2015
Reviewed by: Daniel Kantor, MD, Kantor Neurology, Coconut Creek, FL and Immediate Past President of the Florida Society of Neurology (FSN). Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.