Differential Diagnosis for Altered Mental Status with Whole-Body Shaking but Able to Follow Commands
Single Most Likely Diagnosis
- Seizure (Post-ictal State): The whole-body shaking could be indicative of a seizure, and the ability to follow commands suggests the patient may be in a post-ictal state, where there is often a period of confusion and altered mental status following the seizure.
Other Likely Diagnoses
- Hypoglycemia: Low blood sugar can cause shaking and altered mental status. The ability to follow commands suggests the hypoglycemia may not be severe enough to cause loss of consciousness.
- Thyroid Storm: This condition, associated with hyperthyroidism, can cause tremors, agitation, and altered mental status. Patients may still be able to follow commands, especially in the early stages.
- Alcohol or Drug Withdrawal: Withdrawal from alcohol or certain drugs can cause whole-body shaking (tremors) and altered mental status. The ability to follow commands varies depending on the severity of withdrawal.
Do Not Miss Diagnoses
- Meningitis or Encephalitis: Infections of the brain and meninges can cause altered mental status and seizures or shaking. These conditions are medical emergencies and must be considered, even if less likely.
- Stroke or Transient Ischemic Attack (TIA): While less common, a stroke or TIA can cause sudden onset of shaking and altered mental status. The ability to follow commands does not rule out these conditions.
- Septic Shock: Sepsis can cause altered mental status and shaking due to hypoperfusion and metabolic disturbances. It's a life-threatening condition that requires immediate attention.
Rare Diagnoses
- Neuroleptic Malignant Syndrome (NMS): A rare but life-threatening side effect of neuroleptic medications, characterized by fever, muscle rigidity, and altered mental status. Shaking or tremors can be part of the presentation.
- Serotonin Syndrome: Another rare condition caused by certain medications, leading to altered mental status, muscle rigidity, and autonomic dysfunction. Shaking or tremors can occur.
- Wilson's Disease: A genetic disorder that can cause neurological symptoms, including tremors and altered mental status, due to copper accumulation in the brain. It's rare and typically presents in younger individuals.