Stuporous

Stuporous is a state of depressed consciousness in which a person is largely unresponsive to the surrounding environment but can be roused briefly, typically only with strong or painful stimuli. Speech and purposeful interaction are minimal, though reflexes are usually present and protective reflexes remain intact.

It is intermediate between obtundation and coma; unlike coma, a stuporous person may respond briefly to stimuli, but sustained interaction is not possible. Distinguishing stupor from coma, delirium, or catatonia is important for guiding management and prognosis.

Causes are diverse and include CNS depressant intoxication (opioids, benzodiazepines, alcohol), metabolic disturbances (hypoglycemia, severe electrolyte disorders, hepatic or renal failure), structural brain injury or stroke, infections, toxins, or psychiatric conditions such as catatonia. Pathophysiology often involves disruption of the reticular activating system and thalamocortical networks that regulate wakefulness.

Evaluation focuses on airway and circulation, history, examination, and rapid laboratories (glucose, electrolytes, renal and hepatic function) with tox screens as indicated. Neuroimaging and electroencephalography may be used to identify structural lesions or nonconvulsive seizures. Stupor is a symptom rather than a diagnosis, requiring workup for reversible etiologies when possible.

Management targets the underlying cause and provides supportive care, including airway protection, monitoring, and correction of metabolic abnormalities. Treatments may include antidotes for specific toxins and seizure control; in cases of catatonia, benzodiazepines or electroconvulsive therapy can be considered. Prognosis depends on cause, duration, and comorbidities.