The Case Files: One in a Million: A Rare Cause of Altered Mental Status

By Ringhauser, Holly DO; Glantz, Sanford MD; Havasy, Stephen P. MD A 74-year-old woman presented to the emergency department with altered mental status for one week. The patient's husband said the patient had been in her usual state of health until seven days earlier, when she got lost on the way home from a restaurant that she had frequented for several decades. She had become increasingly confused and unable to care for herself, and was now unable to finish a sentence or ambulate without assistance. The patient had been seen by her primary physician and a neurologist. She had blood work, a CT scan, and an MRI performed, but her husband was not yet aware of the results of these tests.   The patient's past medical history was significant for hypertension and hypercholesterolemia, and her medications included enalapril and ezetimibe with no recent changes in dose or frequency. The patient's husband said the patient did not smoke, drink alcohol, or use any illicit drugs, and he denied any recent travel or sick contacts.   The patient's initial vital signs were within normal limits with the exception of mild hypertension (155/59 mm Hg). Her rectal temperature was 99.2°F, and she remained afebrile throughout her workup. She was confused and disoriented. She answered questions inappropriately and nonsensically. She could follow simple commands, such as opening or closing her eyes, but was unable to follow more complicated instructions, such as putting her finger to her nos...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research