799: CATATONIA AS AN ETIOLOGY OF PERSISTENT ALTERED MENTAL STATUS IN A CRITICALLY ILL PEDIATRIC PATIENT

Electroencephalography (EEG) in critically ill patients allows for monitoring of cerebral function when a clinical examination is limited because of altered mental status or coma. Continuous EEG (cEEG) has increasingly been used to monitor critically ill patients in the intensive care unit (ICU). Implementation of cEEG in the ICU presents a unique set of challenges, requiring special expertise and a multidisciplinary approach.

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A Rare Case of Bartonella Encephalitis With Hemiplegia

Child Neurology Open ◽

10.1177/2329048x19826480 ◽

2019 ◽

Vol 6 ◽

pp. 2329048X1982648 ◽

Cited By ~ 1

Author(s):

Laura Rosas ◽

Kavya Rao ◽

Christine McGough ◽

Ashley Becker

Keyword(s):

Pediatric Patient ◽

Mental Status ◽

Rare Case ◽

Right Hemisphere ◽

Acute Flaccid Paralysis ◽

Altered Mental Status ◽

Flaccid Paralysis ◽

Atypical Presentation ◽

Neurologic Manifestations ◽

Cat Scratch Disease

The authors describe a 12-year-old girl with an atypical presentation of Bartonella encephalitis. She presented with fever and altered mental status and developed flaccid paralysis of her left upper extremity a day later. An electroencephalogram showed slowing over her right hemisphere. She had mild leukocytosis and bandemia, but her imaging and cerebrospinal studies were unrevealing. After five days, her symptoms resolved and she was discharged home on doxycycline due to suspicion for Bartonella encephalitis. The patient admitted to playing with a kitten two months prior, but she lacked the classic regional lymphadenopathy. Bartonella titers were sent during her hospitalization and returned positive after her discharge. Cat scratch disease neurologic manifestations are uncommon, with hemiplegia being exceedingly rare. This case illustrates that focal neurologic signs may develop during cat scratch disease infection and suggests that cat scratch disease encephalitis should be considered during evaluation of a pediatric patient with acute flaccid paralysis.

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Intracranial Tuberculomas: An Unusual Cause of Altered Mental Status in a Pediatric Patient

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2007.10.060 ◽

2010 ◽

Vol 38 (3) ◽

pp. 323-327 ◽

Cited By ~ 4

Author(s):

James D. Krygowski ◽

Delon F.P. Brennen ◽

Francis L. Counselman

Keyword(s):

Pediatric Patient ◽

Mental Status ◽

Altered Mental Status

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Acutely Altered Mental Status as the Main Clinical Presentation of Multiple Strokes in Critically Ill Patients With COVID-19.

10.21203/rs.3.rs-31769/v1 ◽

2020 ◽

Author(s):

Carolina Díaz-Pérez ◽

Carmen Ramos ◽

Alberto López-Cruz ◽

José Muñoz Olmedo ◽

Jimena Lázaro González ◽

...

Keyword(s):

Critically Ill ◽

Mental Status ◽

Critically Ill Patients ◽

Clinical Presentation ◽

Brain Mri ◽

Altered Mental Status ◽

Neurological Deficits ◽

Cutaneous Lesions ◽

Pulmonary Angiogram ◽

Occipital Lobes

Abstract Background and aims:Cerebral infarction in COVID-19 patients might be associated with a hypercoagulable state related to a systemic inflammatory response. Its diagnosis might be challenging. We present two critically ill patients with COVID-19 who presented acutely altered mental status as the main manifestation of multiple strokes.Methods:Clinical presentation and diagnostic work-up of the patients.Results:Two patients in their sixties were hospitalized with a bilateral pneumonia COVID-19. They developed respiratory failure and were admitted to ICU for mechanical ventilation and intense medical treatment. They were started on low-molecular-weight heparin since admission. Their laboratory results showed lymphopenia and increased levels of C-reactive protein and D-dimer. Case 1 developed hypofibrinogenemia and presented several cutaneous lesions with biopsy features of thrombotic vasculopathy. Case 2 was performed a CT pulmonary angiogram at ICU showing a bilateral pulmonary embolism. When waking up, both patients were conscious but with a remarkable global altered mental status without focal neurological deficits. A brain MRI revealed multiple acute bilateral ischemic lesions with areas of hemorrhagic transformation in both patients (Case 1: affecting the left frontal and temporal lobes and both occipital lobes; Case 2: affecting both frontal and left occipital lobes). Cardioembolic source and acquired antiphospholipid syndrome were ruled out. COVID-19-associated coagulopathy was suspected as the possible main etiology of the strokes.Conclusion:Acutely altered mental status might be the main manifestation of multiple brain infarctions in critically ill COVID-19 patients. It should be specially considered in those with suspected COVID-19-associated coagulopathy. Full-dose anticoagulation and clinical-radiological monitoring might reduce their neurological consequences.

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