Causes of Acute Neurological Deterioration
Published: 17 May 2023
Published: 17 May 2023
Early detection of neurological deterioration in patients means interventions are more likely to be successful (Shahrokhi & Asuncion 2023).
Therefore, you must be informed about the possible causes of neurological deterioration, know how to correctly assess the patient and intervene appropriately.
A decrease of two or more points on the Glasgow Coma Scale (GCS), which measures a patient's level of consciousness on a scale of 3 to 15, is a warning sign of neurological deterioration (Shkirkova et al. 2018; Trauma Victoria 2023).
Patients may present in a variety of consciousness states ranging from full alertness and awareness, to some level of impairment, to complete unawareness and unresponsiveness (Cooksley, Rose & Holland 2018).
A patient with a GCS score of less than eight is considered to be neurologically compromised, which is a medical emergency relying on prompt diagnosis and medical management for a favourable patient outcome (Cooksley et al. 2018).
Read: Performing a Neurological Assessment
While a neurological assessment is useful for recognising deterioration, the cause will need to be identified so that the patient can be appropriately treated. The following are some common causes of neurological deterioration:
Sedation-related neurological deterioration may be caused by opiate overdose or anaesthetic that has not been reversed effectively, causing the patient to remain heavily sedated.
The patient may present with:
(Vincent et al. 2018; CEC 2013; Schiller et al. 2022)
Neurological deterioration may be caused by a:
The patient’s pupils may appear unequal. A stroke is a medical emergency and requires early intervention.
(Jeffery et al. 2019; Stroke Foundation 2022)
A patient experiencing a seizure may present with mydriasis (dilated pupils) (Kutlu et al. 2014).
In the case of a seizure, protect the patient and call for assistance.
Hypoglycaemia (abnormally low glucose levels) can cause neurological deterioration, as the brain relies on blood glucose for energy (Harvard Health Publishing 2022). It may be caused by:
(Brutsaert 2019)
Other causes of neurological deterioration include:
(Mayo Clinic 2018)
Early detection of neurological deterioration contributes to successful intervention and favourable patient outcomes. Ensure you:
Note: This article is intended as a refresher and should not replace best-practice care. Always refer to your facility's policy on recognising and responding to acute neurological deterioration.
Question 1 of 3
What change to a patient’s GCS score might indicate neurological deterioration?