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Altered mental status

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https://www.readbyqxmd.com/read/28086917/resveratrol-regulates-neuro-inflammation-and-induces-adaptive-immunity-in-alzheimer-s-disease
#1
Charbel Moussa, Michaeline Hebron, Xu Huang, Jaeil Ahn, Robert A Rissman, Paul S Aisen, R Scott Turner
BACKGROUND: Treatment of mild-moderate Alzheimer's disease (AD) subjects (N = 119) for 52 weeks with the SIRT1 activator resveratrol (up to 1 g by mouth twice daily) attenuates progressive declines in CSF Aβ40 levels and activities of daily living (ADL) scores. METHODS: For this retrospective study, we examined banked CSF and plasma samples from a subset of AD subjects with CSF Aβ42 <600 ng/ml (biomarker-confirmed AD) at baseline (N = 19 resveratrol-treated and N = 19 placebo-treated)...
January 3, 2017: Journal of Neuroinflammation
https://www.readbyqxmd.com/read/28070116/aspergillus-terreus-brain-abscess-complicated-by-tension-pneumocephalus-in-a-patient-with-angiosarcoma
#2
Thejal Srikumar, Smitha Pabbathi, Jorge Fernandez, Sowmya Nanjappa
BACKGROUND Aspergillus terreus is an evolving opportunistic pathogen, and patients with A. terreus often have poor outcomes due to its intrinsic resistance to several systemic antifungal agents. Here we present a unique case of intracranial abscesses of A. terreus in a patient with recurrent angiosarcoma, complicated by development of tension pneumocephalus. CASE REPORT A 67-year old gentleman with history of scalp angiosarcoma with wide excision two years prior presented to the hospital for left arm clumsiness, altered mental status, and low-grade fever...
January 10, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28067468/sticking-to-the-script-a-curious-case-of-confusion-in-an-esrd-patient
#3
Barry R Gorlitsky, John T Herion
A 60-year-old male Dialysis patient presented with altered mental status and Hypertensive Urgency. He had a significant lesion noted on his glans penis. He was treated for infection and hypertension with expectant management, without significant improvement in his mental acuity. Laboratory and radiologic workup were unrevealing for the etiology. Upon detailed review it was noted he had recently been given Acyclovir for a presumed Herpes Simplex Virus infection. He had been prescribed what is considered correct dosing for an ESRD patient...
January 9, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/28064407/hair-cortisol-as-a-marker-of-hypothalamic-pituitary-adrenal-axis-activity-in-female-patients-with-major-depressive-disorder
#4
Ksenia Pochigaeva, Tatiana Druzhkova, Alexander Yakovlev, Mikhail Onufriev, Maria Grishkina, Aleksey Chepelev, Alla Guekht, Natalia Gulyaeva
Hair cortisol is regarded as a promising marker of hypothalamic-pituitary-adrenal axis (HPAA) activity alterations due to stress, somatic and mental health conditions. Hair cortisol was previously reported to be elevated in patients with depression, however the data related to remission and recurrent depressive episodes are different. In this study, levels of hair cortisol were assessed in female patients with major depressive disorder (MDD) and the validity of hair cortisol as a marker of HPAA activity in this condition was evaluated...
January 7, 2017: Metabolic Brain Disease
https://www.readbyqxmd.com/read/28059631/acute-necrotizing-encephalopathy-causing-human-bocavirus
#5
Ayse Betul Ergul, Umit Altug, Kursad Aydin, Ahmet Sami Guven, Yasemin Altuner Torun
Acute necrotizing encephalopathy is characterized by multiple, symmetrical lesions involving the thalamus, brainstem, cerebellum, and white matter and develops secondarily to viral infections. Influenza viruses are the most common etiological agents. Here, we present the first case of acute necrotizing encephalopathy to develop secondarily to human bocavirus. A 3-year-old girl presented with fever and altered mental status. She had had a fever, cough, and rhinorrhea for five days. The patient was admitted to the intensive care unit with an initial diagnosis of encephalitis when vomiting, convulsions, and loss of consciousness developed...
January 1, 2017: Neuroradiology Journal
https://www.readbyqxmd.com/read/28055104/can-we-rule-out-meningitis-from-negative-jolt-accentuation-a-retrospective-cohort-study
#6
Ryota Sato, Akira Kuriyama, Sarah Kyuragi Luthe
BACKGROUND: Jolt accentuation has been considered to be the most sensitive physical finding to predict meningitis. However, there are only a few studies assessing the diagnostic accuracy of jolt accentuation. Therefore, we aimed to evaluate the diagnostic accuracy of jolt accentuation and investigate whether it can be extended to patients with mild altered mental status. METHODS: We performed a single center, retrospective observational study on patients who presented to the emergency department in a Japanese tertiary care center from January 1, 2010 to March 31, 2016...
January 5, 2017: Headache
https://www.readbyqxmd.com/read/28054396/incremental-value-of-contrast-echocardiography-in-the-evaluation-of-a-cardiac-thrombus
#7
Jose Ricardo F Po, Matthew S Tong, Erica L Grove, Robert W W Biederman
A 52-year-old man presented with altered mental status and report of prior complaint of chest pain. On electrocardiography, anterolateral ST-segment elevations with Q-waves in the septal leads were seen. Initial echocardiography images demonstrated a thickened anteroseptum. Further imaging showed the presence of a well-attached laminated apical thrombus. Contrast echocardiography images showed that the thrombus had minimal attachment to the endocardial surface. CT head subsequently showed the presence of acute stroke...
January 5, 2017: Echocardiography
https://www.readbyqxmd.com/read/28054290/treatment-of-hyponatremia-in-patients-with-acute-neurological-injury
#8
Theresa Human, Aaron M Cook, Brian Anger, Kathleen Bledsoe, Amber Castle, David Deen, Haley Gibbs, Christine Lesch, Norah Liang, Karen McAllen, Christopher Morrison, Dennis Parker, A Shaun Rowe, Denise Rhoney, Kiranpal Sangha, Elena Santayana, Scott Taylor, Eljim Tesoro, Gretchen Brophy
BACKGROUND: Little data exist regarding the practice of sodium management in acute neurologically injured patients. This study describes the practice variations, thresholds for treatment, and effectiveness of treatment in this population. METHODS: This retrospective, multicenter, observational study identified 400 ICU patients, from 17 centers, admitted for ≥48 h with subarachnoid hemorrhage (SAH), traumatic brain injury (TBI), intraparenchymal hemorrhage, or intracranial tumors between January 1, 2011 and July 31, 2012...
January 4, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28053849/long-term-outcome-of-medical-and-surgical-co-management-of-craniospinal-aspergillosis-in-an-immunocompromised-patient
#9
Dipu Sathyapalan, Sabarish Balachandran, Anil Kumar, Bindu Mangalath Rajamma, Ashok Pillai, Vidya P Menon
35 yr old steroid dependent lady with Pulmonary TB underwent debridement of epidural abscess & posterior stabilization for paraparesis. With histopathology and cultures showing Aspergillus fumigatus, voricanozole was started. By the fourth week, she developed persistent fever, and altered mental status. Brain MRI and CSF study including multiplex PCR evaluation confirmed cerebral aspergillosis. Voricanozole was changed to intravenous lipid complex Amphotericin B to achieve sustained clinical and radiological response after six months of therapy...
December 2016: Medical Mycology Case Reports
https://www.readbyqxmd.com/read/28042369/oral-baclofen-withdrawal-resulting-in-progressive-weakness-and-sedation-requiring-intensive-care-admission
#10
Bret D Alvis, Christopher M Sobey
Baclofen is a common medication used as a muscle relaxant and antispasmodic. Baclofen-withdrawal syndrome has many symptoms such as sedation, somnolence, and weakness but can include psychological symptoms. We present a 62-year-old female whose oral baclofen was not continued at a skilled nursing facility after discharge following inpatient surgery that led to the development of altered mental status and respiratory insufficiency necessitating intensive care unit admission. Abrupt cessation of baclofen, no matter the mode of administration to the patient, can lead to baclofen-withdrawal syndrome...
January 2017: Neurohospitalist
https://www.readbyqxmd.com/read/28042366/posterior-reversible-encephalopathy-syndrome-local-experience-from-saudi-arabia
#11
Hussein Algahtani, Abdulhadi Algahtani, Ahmad Aldarmahi, Mohammed Hmoud, Yousef Marzuk, Bader Shirah
OBJECTIVES: Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome characterized by headache, altered mental status, seizures, or loss of vision. In this study, we report the largest series of PRES coming from Saudi Arabia and explore the etiology, clinical presentation, and outcome. We also report new imaging findings associated with this condition. METHODS: We performed a retrospective study of all cases of PRES admitted to King Abdulaziz Medical City, Jeddah, Saudi Arabia, between the years 2005 and 2015...
January 2017: Neurohospitalist
https://www.readbyqxmd.com/read/28041546/-epidural-abscess-secondary-to-sinusitis
#12
Pernille Henriksen, Noushin Yazdanyar, Lisbeth Samsø Schmidt, Marianne Sjølin Frederiksen
Approximately 0.5-2% of upper viral infections are com-licated by secondary acute bacterial sinusitis and may in rare cases evolve into more serious complications such as meningitis and intracranial abscess. Symptoms are often subtle and nonspecific as fever, headache, scalp tenderness, nausea and altered mental status. In this case report of a 12-year-old boy with an epidural abscess secondary to sinusitis we intend to increase the knowledge to these rare, but potentially life-threatening complications to ensure the optimal and timely treatment...
December 26, 2016: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/28008165/tuberculous-meningitis-in-an-immunocompetent-host-a-case-report
#13
Suchin R Khanna, Stephen M Kralovic, Rajan Prakash
BACKGROUND Tuberculous meningitis is very rare in the United States in immunocompetent hosts. Risk factors are similar to those of pulmonary tuberculosis, including poverty, malnutrition, overcrowding, a compromised immune system, and coming from an endemic area. Meningeal tuberculosis mortality and other outcomes have changed little over time despite effective therapies due to delay in diagnosis because of its rarity, variable presentation, and often indolent course. CASE REPORT We describe a case of a 57-year-old male immigrant from Senegal with no significant past medical history and no previous history of tuberculosis or evidence of immune compromise...
December 23, 2016: American Journal of Case Reports
https://www.readbyqxmd.com/read/27999693/severe-anemia-with-hemoperitoneum-as-a-first-presentation-for-multinodular-hepatocellular-carcinoma-a-rare-event-in-western-countries
#14
Thein Swe, Akari Thein Naing, Aama Baqui, Ratesh Khillan
Hemoperitoneum due to spontaneous rupture of hepatocellular carcinoma is a life-threatening and rare condition in western countries with an incidence of less than 3% because of early detection of cirrhosis and neoplasm. Here, we describe a case of a 66-year-old male patient with altered mental status with hemorrhagic shock. Computed tomography scan of abdomen revealed hemoperitoneum and mass in liver. Patient underwent resection of liver tumor and biopsy revealed multinodular hepatocellular carcinoma. A high degree of suspicion is required where severe anemia and hemoperitoneum can be a first presentation for hepatocellular carcinoma especially in patients with chronic hepatitis C infection...
2016: Case Reports in Hepatology
https://www.readbyqxmd.com/read/27989537/delayed-cardiac-tamponade-a-rare-but-life-threatening-complication-of-catheter-ablation
#15
Elizabeth Yetter, Jared Brazg, Diane Del Valle, Laura Mulvey, Eitan Dickman
Delayed cardiac tamponade (DCT) is a rare and life-threatening complication of catheter ablation performed as a treatment of atrial fibrillation, with few cases described in the medical literature. We present the case of a 57year-old man presenting with DCT 61days following a catheter ablation procedure. To the best of our knowledge, this is the most delayed case of cardiac tamponade (CT) following catheter ablation described in the literature. We also discuss the importance of point of care ultrasound (POCUS) in the diagnosis and treatment of CT...
November 17, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27984401/who-orders-a-head-ct-perceptions-of-the-cirrhotic-bleeding-risk-in-an-international-multispecialty-survey-study
#16
Laura M Mazer, Marie Méan, Elliot B Tapper
OBJECTIVE: Traditional coagulopathic indices, including elevated international normalized ratio, do not correlate with bleeding risk in patients with cirrhosis. For this reason, head computed tomography (CT) has a low yield in cirrhotic patients with altered mental status and no trauma history. The initial diagnostic evaluation, however, is often made by nongastroenterologists influenced by the so-called "coagulopathy of cirrhosis." We sought to examine the prevalence, impact, and malleability of this perception in an international, multispecialty cohort...
December 14, 2016: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/27979049/medical-management-of-severe-alcoholic-hepatitis-expert%C3%A2-review-from-the-clinical-practice-updates-committee-of%C3%A2-the-aga-institute
#17
Mack C Mitchell, Lawrence S Friedman, Craig J McClain
The purpose of this clinical practice update is to review diagnostic criteria for severe acute alcoholic hepatitis and to determine the current best practices for this life-threatening condition. The best practices in this review are based on clinical trials, systematic reviews including meta-analysis and expert opinion to develop an approach to diagnosis and management. Best Practice Advice 1: Abstinence from drinking alcohol is the cornerstone of treatment for alcohol hepatitis (AH). Best Practice Advice 2: Patients with jaundice and suspected AH should have cultures of blood, urine, and ascites, if present, to determine the presence of bacterial infections regardless of whether they have fever...
January 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/27966026/retrospective-study-of-unplanned-hospital-admission-for-metastatic-cancer-patients-visiting-the-emergency-department
#18
Tae Tanaka, Masataka Taguri, Soichi Fumita, Kunio Okamoto, Yoshio Matsuo, Hidetoshi Hayashi
PURPOSE: The purpose of the study was to identify factors that predict unplanned admission for metastatic cancer patients visiting the emergency department (ED). METHODS: Patients visiting the ED of a general hospital from April 2012 to March 2013 were investigated retrospectively. Data including demographics, vital signs, and laboratory measurements were collected from a chart review for each patient. Factors related to emergency admission were identified by univariate and multivariate analyses...
December 13, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/27956448/delirium-a-guide-for-the-general-physician
#19
Oliver M Todd, Elizabeth A Teale
Delirium describes a sudden onset change in mental status of fluctuating course. This is a state of altered consciousness characterised chiefly by inattention or lack of arousal, but can also include new impairment of language, perception and behaviour. Certain predisposing factors can make an individual more susceptible to delirium in the face of a stressor. Stressors include direct insults to the brain, insults peripheral to the brain or external changes in the environment of an individual. Delirium is varied in its presentation, and can be categorised by the psychomotor profile as: hyperactive type (overly vigilant, agitated, often wandersome), hypoactive type (sedate or withdrawn) or mixed types...
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27956173/venous-infarction-mimicking-top-of-basilar-syndrome-an-uncommon-complication-of-adult-influenza-infection
#20
Soo Hyun Cho, Kyung Mi Lee, Bum Joon Kim, Jae Hong Yi, Kyung Chul Noh, Eui Jong Kim, Hak Young Rhee, Key-Chung Park
Influenza infection increases the risk of ischemic stroke. Here, we represent a case of a 32year-old female who presented with acutely developed altered mental status after influenza A infection. The clinical manifestation and initial lesion on brain DWI mimicked top of basilar syndrome, but without an arterial occlusion or stenosis. Follow-up neuro imaging analysis suggested cerebral venous infarction. It is valuable to report this case of venous infarction in a healthy young adult, as an uncommon complication of adult influenza infection...
December 9, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
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