Heat Stroke

2018 ◽  
pp. 332-335
Author(s):  
Alexander Berk
Keyword(s):  
Differential Diagnosis ◽  
Mental Status ◽  
Heat Stroke ◽  
Altered Mental Status ◽  
Healthy Person ◽  
Clinical Suspicion ◽  
Metabolic Abnormalities ◽  
Airway Protection ◽  
Stroke Patients ◽  
High Clinical Suspicion

This case illustrates heat stroke presenting as altered mental status in a young healthy person. The differential diagnosis of altered mental status with hyperthermia is broad so a high clinical suspicion is needed to make the diagnosis of heat stroke. Infectious causes should always be ruled out. Once the diagnosis is made, treatment is aimed at actively cooling the patient, lowering temperature to a targeted goal of 102.2°F. Close attention should also be given to airway protection, correction of metabolic abnormalities, evaluation for rhabdomyolysis, and monitoring for cardiac dysrhythmias. All heat stroke patients should be admitted to the hospital for monitoring even after cooling goals are achieved.

scholarly journals Non-convulsive status epilepticus: an often-overlooked etiology of syndrome of inappropriate antidiuretic hormone secretion

2017 ◽  
Vol 5 (5) ◽  
pp. 2251
Author(s):  
Elizabeth Davis ◽  
Rima Chakraborty
Keyword(s):  
Differential Diagnosis ◽  
Status Epilepticus ◽  
Mental Status ◽  
Hormone Secretion ◽  
Altered Mental Status ◽  
Convulsive Status Epilepticus ◽  
Chronic Medical Conditions ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Chronic Hyponatremia

Altered mental status is a common presenting complaint in adult medicine with a broad differential diagnosis. When found in the context of chronic medical conditions, less common etiologies can be overlooked. We present a case of acute altered mental status thought to be secondary to acute on chronic hyponatremia in the context of syndrome of inappropriate antidiuretic hormone secretion (SIADH), eventually diagnosed as non-convulsive status epilepticus, partial type. We report the case of a 67-year-old patient with known SIADH of unknown etiology, hypertension, chronic pancreatitis and chronic obstructive pulmonary disease (COPD) who presented with fatigue, myalgia, decreased urine output. On presentation patient also had profound acute on chronic hyponatremia. During sodium correction, the patient developed an acute, progressive decline in mental status. Vital signs remained stable and workup including LP and MRI were negative. Initial electroencephalographic (EEG) showed no definitive seizure activity, but did show bifrontal focal continuous slowing. The patient’s mental status continued to decline and upon further evaluation it was suggested that the EEG findings and the patient’s progressive AMS could be compatible with non-convulsive status epilepticus. The patient received loading doses of IV lorazepam and levetiracetam and within 48 hours after initial treatment was back to baseline. Non-convulsive status epilepticus is a common, but heterogeneous subclass of status epilepticus that is difficult to diagnose. This case demonstrates the difficulty of diagnosing normalized corrected Shannon entropy (NCSE) in the context of other chronic medical conditions and the importance of including it on any differential diagnosis for acute change in mental status. 

scholarly journals When a Seemingly Harmless Prescription Turns into Toxicity

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Zurab Azmaiparashvili ◽  
Kevin Bryan Lo ◽  
Nawal Habib ◽  
Annie Hsieh
Keyword(s):  
Renal Function ◽  
Differential Diagnosis ◽  
Herpes Zoster ◽  
Cognitive Function ◽  
Mental Status ◽  
Complete Resolution ◽  
Impaired Renal Function ◽  
Supportive Therapy ◽  
The Elderly ◽  
Altered Mental Status

Valacyclovir neurotoxicity is commonly seen in the elderly and those with impaired renal function. Differential diagnosis can be challenging as a myriad of medical conditions, including herpes zoster virus associated encephalitis, may present in a similar fashion. We present a case of a 71-year-old male who presented with altered mental status in the setting of recent herpes zoster eruption. His condition was attributed to valacyclovir neurotoxicity, and initiation of appropriate supportive therapy was met with complete resolution of symptoms and normalization of cognitive function.

Abstract TP295: Predictability of Stroke Symptoms in Acute Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Maria J Bruzzone ◽  
Luka Vlahovic ◽  
Ramon Durazo ◽  
Sean Ruland
Keyword(s):  
Acute Stroke ◽  
Mental Status ◽  
Healthcare Providers ◽  
Signs And Symptoms ◽  
Altered Mental Status ◽  
Final Diagnosis ◽  
Facial Weakness ◽  
Stroke Patients ◽  
Accurate Identification ◽  
Limb Weakness

Background: Prompt signs and symptoms recognition and intervention are essential to achieve the best outcome after stroke. Stroke codes were developed to expedite assessment and treatment. Their optimal use requires accurate identification of stroke patients. In order to improve diagnostic accuracy in our institution, we analyzed the predictive value of individual stroke signs and symptoms in patients in whom stroke codes were activated from the emergency department (ED) by physicians and nurses and from inpatient wards by nurses, residents and hospitalists. Methods: We retrospectively analyzed 501 consecutive stroke codes in our stroke log from May 2013 to May 2015. Age, gender, presenting signs and symptoms, medical history and final diagnosis were assessed. Patients were classified as stroke (ischemic and hemorrhagic) or non-stroke based on the final impression after the completed work-up. X2 statistic was utilized to assess associations. Results: Overall, 202 (40.3%) patients were classified as stroke and 299 (59.7%) non-stroke. 78% of stroke codes were activated from ED and 22% from the inpatient wards. Unilateral limb weakness, aphasia and facial weakness were associated with stroke (p<0.05) with PPVs of 0.57 (95%CI 50-64%), 0.56 (43-68%), 0.51 (43-60%), respectively. Altered mental status (AMS) and sensory symptoms were associated with non-stroke (p<0.05). The PPV and NPV for stroke were 0.21 (95%CI 13-31%) and 0.55 (50-60%) for AMS respectively and 0.25 (14-39%) and 0.58 (43-63%) for sensory symptoms. Location of the stroke code (ED or inpatient ward) did not impact the results. Conclusion: Previous studies, based on evaluation of acute stroke by paramedics and ED physicians, demonstrated that some signs or symptoms are more likely to be present in patients experiencing acute stroke. In our experience, unilateral limb weakness, aphasia, and facial weakness as identified by diverse provider disciplines and experience levels are associated with a final diagnosis of acute stroke. However, isolated altered mental status or sensory symptoms seldom result in a final diagnosis of stroke. These data can assist healthcare providers, to more accurately identify stroke patients, thus improving outcomes as well as resources utilization.

School Nurses on the Front Lines of Medicine: Uppers and Downers: The Approach to the Student With Altered Mental Status

2017 ◽  
Vol 32 (6) ◽  
pp. 350-355 ◽  
Author(s):  
Kelly Patterson ◽  
Jodi Brady ◽  
Robert P. Olympia
Keyword(s):  
Substance Use ◽  
Differential Diagnosis ◽  
Mental Status ◽  
School Setting ◽  
Altered Mental Status ◽  
School Nurses ◽  
Screening Tools ◽  
Initial Assessment ◽  
Detection Of Depression

Although a student presenting with altered mental status due to substance use may occur infrequently in the school setting, it is of utmost importance to develop a differential diagnosis and to initiate stabilization of the student. This article describes the initial assessment and management of a student presenting with altered mental status, focusing on the differential diagnosis of altered mental status, on the varying presentations associated with common intoxications and ingestions, and on the screening tools available for the detection of depression and substance use.

Neurology in the psychiatric patient: how to think about differentials in altered mental status and diagnoses not to miss

2021 ◽  
pp. 1-13
Author(s):  
Jonathan McLaughlin ◽  
Tim Young
Keyword(s):  
Differential Diagnosis ◽  
Mental Status ◽  
Psychiatric Patient ◽  
Common Ground ◽  
Altered Mental Status ◽  
Management Plan ◽  
Case Vignettes ◽  
Neurological Conditions ◽  
Set Up ◽  
Careful History

SUMMARY A wide variety of neurological conditions may present first to a psychiatrist and it is important to be aware of these in differential diagnosis. A careful history, examination and a broad differential diagnosis can help set up an appropriate management plan – with room to change if things change in unexpected ways. In this article we explore common ground shared by psychiatry and neurology and show how incorporation of neurological knowledge can improve the practice of psychiatry. Using four fictional case vignettes of altered mental status we explore important neurological differential diagnoses which could present to the Psychiatrist.

scholarly journals 40-year-old Male with a Headache and Altered Mental Status

2020 ◽  
Vol 4 (4) ◽  
pp. 499-504
Author(s):  
Rebecca Rubenstein ◽  
Leen Alblaihed ◽  
Zachary Dezman ◽  
Laura Bontempo
Keyword(s):  
Magnetic Resonance Imaging ◽  
Emergency Department ◽  
Differential Diagnosis ◽  
Magnetic Resonance ◽  
Mental Status ◽  
Altered Mental Status ◽  
Resonance Imaging ◽  
Status Change ◽  
Mental Status Change ◽  
The Brain

A 40-year-old man presents to the emergency department with headache, nausea and paresthesias, with subsequent fever and mental status change. Magnetic resonance imaging showed increased fluid-attenuation inversion recovery signal involving multiple areas of the brain, including the pons. This case takes the reader through the differential diagnosis of rhombencephalitis (inflammation of the hindbrain) with discussion of the unanticipated ultimate diagnosis and its treatment.

scholarly journals Risk Factors Related to Falling in Patients after Stroke

2021 ◽  
Author(s):  
Olivera Djurovic ◽  
Olgica Mihaljevic ◽  
Snezana Radovanovic ◽  
Smiljana Kostic ◽  
Marjana Vukicevic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mental Status ◽  
Altered Mental Status ◽  
Cerebrovascular Diseases ◽  
Stroke Patients ◽  
Retrospective Case ◽  
Factors Associated ◽  
Healthcare Needs ◽  
Unmet Healthcare Needs ◽  
Significant Difference

Background: The aim of this study was to identify the risk factors associated with falling in post stroke patients. Methods: This retrospective case-control study included 561 neurology patients hospitalized for a stroke and divided into two groups: falling patients and non-falling patients. They referred to the Special Hospital for Cerebrovascular Diseases "Sveti Sava" in Belgrade, Serbia, from 2018- 2019. Logistic regression analysis was applied to examine socio-economic factors associated with predictors of unmet healthcare needs. Results: A significant difference was seen in the length of hospitalization of falling patients compared to the non-falling (P<0.001). We established statistically significant differences in mental status (P<0.001), sensibility (P=0.016), depressed mood (P<0.001), early (P=0.001) and medium insomnia (P=0.042), psychomotor slowness (P=0.030), somatic anxiety (P=0.044) and memory (P<0.001). Conclusion: Cerebrovascular disease distribution and the degree of neurological deficit primarily altered mental status, which could be recognized as one of the more important predictors for falling after stroke. The identification of risk factors may be a first step toward the design of intervention programs for preventing a future fall among hospitalized stroke patients.

scholarly journals Spectrum of right iliac fossa mass differential diagnosis and their management

2019 ◽  
Vol 6 (7) ◽  
pp. 2312
Author(s):  
G. V. V. Prasad Reddy ◽  
Konappa V. ◽  
V. Mahidhar Reddy ◽  
Dharmendra Kumar
Keyword(s):  
Differential Diagnosis ◽  
Prospective Observational Study ◽  
Histopathological Examination ◽  
Psoas Abscess ◽  
Iliac Fossa ◽  
Malignant Lesion ◽  
Clinical Suspicion ◽  
Anatomical Structures ◽  
Medical College ◽  
High Clinical Suspicion

Background: Right iliac fossa mass is a common clinical entity encountered in routine surgical practice. The mass arises from different anatomical structures with varied aetiologies that require a high clinical suspicion in its management. The reason being that the mass may range from being benign to most aggressively malignant lesion which encompasses various specialities of surgery like genitourinary, vascular, gynaecological and colorectal surgery.Methods: This was a prospective observational study conducted between august 2015 and October 2017 in Narayan Medical College and Hospital, Nellore. 50 cases were studied after detailed history and physical examination, relevant investigations were done, and different surgical procedures done were noted and histopathological examination of resected specimens was done.Results: In this series out of 50 patients studied, 23 patients (46%) were diagnosed to have appendicular mass, 10 cases (20%) ileocaecal TB, 8 cases (16%), appendicular abscess, 6 cases (12%) CA Caecum, 3 cases (6%) psoas abscess. Most commonly encountered in 3rd decade of life with male predominance.Conclusions: RIF mass is a challenging clinical scenario for the surgeons. Keeping in mind the various differential diagnosis with good clinical acumen supported by appropriate investigations, patients with RIF mass can be managed appropriately either by conservative or surgical management. 

scholarly journals A Chemist with a Strange Etiology of Rhabdomyolysis: A Case Report of a Rare Toxicological Emergency

2021 ◽  
Vol 5 (4) ◽  
pp. 432-435
Author(s):  
Rajadurai Meenakshisundaram ◽  
Joshua Joseph ◽  
Prabakaran Perumal ◽  
Akmal Areeb ◽  
Prathap Pancheti ◽  
...  
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Mental Status ◽  
Creatine Phosphokinase ◽  
Altered Mental Status ◽  
Protective Equipment ◽  
General Anaesthetic ◽  
Airway Protection ◽  
Halogenated Hydrocarbon ◽  
Adequate Knowledge

Introduction: Chloroform, a halogenated hydrocarbon, causes central nervous depression, hepatotoxicity, nephrotoxicity, and rhabdomyolysis. Historically, chloroform had been used as a general anaesthetic and today is still used in chemical industries. Lack of proper personal protective equipment and adequate knowledge about its toxic effects can lead to serious harm. Case report: A 33-year-old gentleman presented to the emergency department (ED) with altered mental status. Given his depressed mental status, the decision was made to intubate shortly after arrival for airway protection. Further history raised suspicion of occupational chloroform exposure. Brown-colored urine further strengthened suspicion of chloroform poisoning with resultant rhabdomyolysis. Forced alkaline diuresis and N-acetylcysteine were started in the ED. His mental status and respiratory efforts improved on hospital day two, and he was ultimately extubated. Creatine phosphokinase and myoglobin levels were initially high but gradually came down by hospital day six. On hospital day 10, the patient was deemed stable and safely discharged. Conclusion: A patient with chloroform inhalation who suffered resultant rhabdomyolysis and hepatotoxicity was successfully treated with early initiation of forced alkaline diuresis, N-acetylysteine, and hemodialysis.

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