A man in his 40s with altered mental status, ataxia and unilateral weakness

2016 ◽  
Vol 37 (3) ◽  
pp. 286-290
Author(s):  
Konark Malhotra ◽  
Monica Khunger ◽  
Cunfeng Pu ◽  
Thomas F. Scott
Keyword(s):  
Mental Status ◽  
Altered Mental Status ◽  
Unilateral Weakness

Transient altered mental status and leptomeningeal enhancement associated with pembrolizumab: a case report

2021 ◽  
Author(s):  
Keng Lam ◽  
Sameer K. Kulkarni ◽  
Manya Khrlobyan ◽  
Pamela K. Cheng ◽  
Caroline L. Fong
Keyword(s):  
Case Report ◽  
Mental Status ◽  
Altered Mental Status ◽  
Leptomeningeal Enhancement

scholarly journals Recurrent noncirrhotic hyperammonemia causing acute metabolic encephalopathy in a patient with a continent ileocecal pouch: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
T. M. Skipina ◽  
S. Macbeth ◽  
E. L. Cummer ◽  
O. L. Wells ◽  
S. Kalathoor
Keyword(s):  
Emergency Department ◽  
Metabolic Acidosis ◽  
Mental Status ◽  
Rare Case ◽  
Liver Function Tests ◽  
Altered Mental Status ◽  
Potassium Citrate ◽  
Metabolic Encephalopathy ◽  
History Of ◽  
Normal Urine

Abstract Introduction Acute encephalopathy, while a common presentation in the emergency department, is typically caused by a variety of metabolic, vascular, infectious, structural, or psychiatric etiologies. Among metabolic causes, hyperammonemia is relatively common and typically occurs in the setting of cirrhosis or liver dysfunction. However, noncirrhotic hyperammonemia is a rare occurrence and poses unique challenges for clinicians. Case presentation Here we report a rare case of a 50-year-old Caucasian female with history of bladder cancer status post chemotherapy, radical cystectomy, and ileocecal diversion who presented to the emergency department with severe altered mental status, combativeness, and a 3-day history of decreased urine output. Her laboratory tests were notable for hyperammonemia up to 289 μmol/L, hypokalemia, and hyperchloremic nonanion gap metabolic acidosis; her liver function tests were normal. Urine cultures were positive for Enterococcus faecium. Computed tomography imaging showed an intact ileoceal urinary diversion with chronic ileolithiasis. Upon administration of appropriate antibiotics, lactulose, and potassium citrate, she experienced rapid resolution of her encephalopathy and a significant reduction in hyperammonemia. Her hyperchloremic metabolic acidosis persisted, but her hypokalemia had resolved. Conclusion This case is an example of one of the unique consequences of urinary diversions. Urothelial tissue is typically impermeable to urinary solutes. However, when bowel segments are used, abnormal absorption of solutes occurs, including exchange of urinary chloride for serum bicarbonate, leading to a persistent hyperchloremic nonanion gap metabolic acidosis. In addition, overproduction of ammonia from urea-producing organisms can lead to abnormal absorption into the blood and subsequent oversaturation of hepatic metabolic capacity with consequent hyperammonemic encephalopathy. Although this is a rare case, prompt identification and treatment of these metabolic abnormalities is critical to prevent severe central nervous system complications such as altered mental status, coma, and even death in patients with urinary diversions.

scholarly journals Altered mental status is an independent predictor of mortality in hospitalized COVID-19 patients

2021 ◽  
Author(s):  
Marjorie J. Kenerly ◽  
Priyank Shah ◽  
Hiten Patel ◽  
Rilee Racine ◽  
Yash Jani ◽  
...  
Keyword(s):  
Mental Status ◽  
Independent Predictor ◽  
Altered Mental Status

scholarly journals Altered mental status with mirror giant middle cerebral artery aneurysms: A case report

2021 ◽  
pp. 101154
Author(s):  
Kamil W. Nowicki ◽  
Jasmine L. Hect ◽  
Nallamai Muthiah ◽  
Arka N. Mallela ◽  
Benjamin M. Zussman
Keyword(s):  
Case Report ◽  
Middle Cerebral Artery ◽  
Mental Status ◽  
Cerebral Artery ◽  
Altered Mental Status ◽  
Middle Cerebral Artery Aneurysms

scholarly journals PROLONGED HYPERCALCEMIA FROM ANTIBIOTIC-ELUTING CALCIUM SULFATE BEADS

2019 ◽  
Vol 5 (6) ◽  
pp. e349-e351 ◽  
Author(s):  
Amy Vora ◽  
Sadia Ali
Keyword(s):  
Renal Failure ◽  
Mental Status ◽  
Serum Calcium ◽  
Calcium Sulfate ◽  
Volume Overload ◽  
Altered Mental Status ◽  
Caucasian Woman ◽  
Local Antibiotics ◽  
Joint Infections ◽  
Severe Hypercalcemia

Objective: Calcium sulfate beads (CSBs) are biocompatible hydrophilic crystals that are used to deliver local antibiotics in periprosthetic joint infections. Hypercalcemia after placement of CSBs is uncommon and poorly understood. Methods: We present the case of a woman who presented with symptomatic hypercalcemia after placement of antibiotic-eluting CSBs. Results: A 58-year-old, Caucasian woman presented with altered mental status, respiratory failure, and septic shock 2 days after placement of antibiotic-eluting CSBs for a left prosthetic hip infection. Laboratory analysis revealed severe hypercalcemia at presentation. She had no known history of fractures, kidney stones, parathyroid, or calcium disorders. She was not on any medications that could induce hypercalcemia. She was treated with aggressive intravenous hydration and 8 doses of calcitonin. Due to impaired renal function, bisphosphonate was contraindicated. She subsequently became anuric with worsening renal failure and volume overload and the decision was made to initiate dialysis. She received 8 days of continuous renal replacement therapy followed by 2 sessions of hemodialysis which improved her serum calcium levels, mental status, and renal failure with no long-term complications. Conclusion: Hypercalcemia secondary to the placement of antibiotic-eluting CSBs is rare. Larger volumes of CSBs may contribute to hypercalcemia. In some cases, hypercalcemia can be severe and symptomatic as in the case of our patient. Serum calcium levels should be monitored frequently after placement of CSBs and managed as appropriate.

scholarly journals The Optimal Management of Acute Febrile Encephalopathy in the Aged Patient: A Systematic Review

2016 ◽  
Vol 2016 ◽  
pp. 1-13 ◽  
Author(s):  
Fereshte Sheybani ◽  
HamidReza Naderi ◽  
Sareh Sajjadi
Keyword(s):  
Systematic Review ◽  
Mental Status ◽  
The Elderly ◽  
Altered Mental Status ◽  
Cns Infection ◽  
Geriatric Syndrome ◽  
World Population ◽  
Main Process ◽  
Optimal Management ◽  
Language Restriction

The elderly comprise less than 13 percent of world population. Nonetheless, they represent nearly half of all hospitalized adults. Acute change in mental status from baseline is commonly seen among the elderly even when the main process does not involve the central nervous system. The term “geriatric syndrome” is used to capture those clinical conditions in older people that do not fit into discrete disease categories, including delirium, falls, frailty, dizziness, syncope, and urinary incontinence. Despite the growing number of elderly population, especially those who require hospitalization and the high burden of common infections accompanied by encephalopathy among them, there are several unresolved questions regarding the optimal management they deserve. The questions posed in this systematic review concern the need to rule out CNS infection in all elderly patients presented with fever and altered mental status in the routine management of febrile encephalopathy. In doing so, we sought to identify all potentially relevant articles using searches of web-based databases with no language restriction. Finally, we reviewed 93 research articles that were relevant to each part of our study. No prospective study was found to address how should AFE in the aged be optimally managed.

Atrial Esophageal Fistula Secondary to Ablation for Atrial Fibrillation

2017 ◽  
Vol 12 (4) ◽  
pp. e3-e5 ◽  
Author(s):  
Lily K. Fatula ◽  
William D. Bolton ◽  
Allyson L. Hale ◽  
Barry R. Davis ◽  
James E. Stephenson ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Mental Status ◽  
Cardiopulmonary Arrest ◽  
Altered Mental Status ◽  
Postoperative Recovery ◽  
Atrial Fibrillation Ablation ◽  
Esophageal Fistula ◽  
Chest Computed Tomography ◽  
Fistula Treatment

This article describes 2 patients who presented to our institution with left atrial esophageal fistula after atrial fibrillation ablation; it also compares our experience with other atrial esophageal fistula cases reported in the literature. We performed a retrospective review of 2 patients who presented to our hospital between July 2015 and September 2015 with atrial esophageal fistula. Patient A, a 57-year-old man, presented 31 days postablation with a fever and right-sided weakness. A chest computed tomography showed gas in the left atrium and esophagus; an echocardiogram confirmed the diagnosis of atrial esophageal fistula. The patient subsequently underwent a left thoracotomy. Postoperative recovery was poor and included significant coagulopathy, sepsis, cardiogenic shock, and multisystem organ failure. The patient died on postoperative day 28. Patient B, a 77-year-old man, presented 21 days post-atrial fibrillation ablation with left-arm weakness and altered mental status. An esophagram was performed and showed no evidence of an esophageal perforation. Because of positive cultures and worsening altered mental status, the patient underwent a head computed tomography, which showed pneumocephalus, leading to our suspicion of the atrial esophageal fistula. A follow-up chest computed tomography confirmed the atrial esophageal fistula. Treatment included an esophagectomy and repair of the atrium. Unfortunately, the atrial esophageal fistula closure dehisced, and the patient developed acute respiratory failure and cardiac tamponade, which led to cardiopulmonary arrest, and the patient died on postoperative day 10. Based on our experience, and the literature, we recommend that a chest computed tomography be immediately performed on patients presenting with the described symptoms after a recent atrial fibrillation ablation.

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