What are the management and evaluation steps for a patient experiencing confusion after a forced sneeze?

From the Guidelines

Management of a patient experiencing confusion after a forced sneeze should begin with a rapid neurological assessment to rule out serious conditions like subarachnoid hemorrhage or stroke. First, assess vital signs and perform a focused neurological examination including level of consciousness, pupillary responses, and motor function. Obtain a detailed history about the timing and nature of the confusion, associated symptoms like headache or visual disturbances, and any relevant medical history such as hypertension or prior neurological events. Urgent neuroimaging with a non-contrast CT scan of the head is recommended, potentially followed by MRI if the CT is negative but clinical suspicion remains high. Laboratory tests should include complete blood count, electrolytes, glucose, and toxicology screening if appropriate. The confusion may result from a transient increase in intracranial pressure during the Valsalva maneuver of sneezing, or it could indicate a more serious underlying condition like an aneurysm or arteriovenous malformation. While awaiting definitive diagnosis, the patient should be monitored closely, kept in a calm environment, and provided supportive care. Depending on findings, consultation with neurology or neurosurgery may be necessary. Follow-up should be arranged based on the severity and persistence of symptoms, with clear instructions to return immediately if symptoms worsen.

Some key points to consider in the management of such a patient include:

• Assessing the patient's airway, breathing, and circulation (ABCs) and ensuring they are stable before proceeding with further evaluation
• Using a systematic approach to evaluate the patient's neurological status, such as the CURB-65 score 1, to identify potential causes of confusion
• Considering the potential for respiratory complications, such as those outlined in the guidelines for the management of asthma 1
• Being aware of the potential for airway emergencies, such as those discussed in the guidelines for the management of tracheostomy and laryngectomy airway emergencies 1
• Following guidelines for infection control, such as those outlined for patients with COVID-19 1 or novel influenza A/H1N1 1, to minimize the risk of transmission to others.

Overall, the management of a patient experiencing confusion after a forced sneeze requires a thorough and systematic approach to identify the underlying cause and provide appropriate treatment.

From the Research

Management and Evaluation Steps

• The first step in managing a patient experiencing confusion after a forced sneeze is to assess their airway, breathing, and circulation (ABCs) to ensure they are stable 2.
• A thorough medical history should be taken to identify any pre-existing conditions that may have contributed to the confusion, such as neurological or respiratory disorders 2, 3.
• A physical examination should be performed to check for any signs of injury or trauma, particularly to the head or neck, which could have occurred as a result of the forced sneeze 2, 4.
• If the patient is an elderly individual, a head computed tomography (CT) scan may be considered to rule out any acute neurological events, such as a stroke or hemorrhage, especially if they have a history of falls or neurological deficits 4, 5.
• The presence of focal neurological deficits, such as weakness or numbness, is a strong predictor of abnormal head CT findings and should be carefully evaluated 5.

Diagnostic Considerations

• The diagnosis of confusion after a forced sneeze should consider various potential causes, including:
  • Traumatic injuries to the head or neck 2
  • Neurological disorders, such as epilepsy or posterior inferior cerebellar artery syndrome 3
  • Psychogenic pathologies, such as anxiety or stress 3
  • Medication side effects, such as benzodiazepines, which can cause cognitive impairment 6
• A comprehensive diagnostic workup, including laboratory tests and imaging studies, may be necessary to determine the underlying cause of the confusion 2, 4, 5.

Treatment and Prognosis

• Treatment of confusion after a forced sneeze will depend on the underlying cause and may involve addressing any underlying medical conditions, such as neurological or respiratory disorders 2, 3.
• In cases where the confusion is caused by a traumatic injury, treatment may involve surgical intervention or other medical interventions to manage the injury 2.
• The prognosis for patients experiencing confusion after a forced sneeze will depend on the underlying cause and the severity of the condition, as well as the effectiveness of treatment 2, 4, 5.