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.

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.

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.

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.

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
Sign in / Sign up

Export Citation Format

Share Document