60 yo F Patient works in the IT department of Ford, recently retired
CC: ALTERED MENTAL STATUS
Later: RRT called for : Tachycardia, BP elevated at 160, she was calling for help, diaphoretic
Vitals upon arrival:
BP: 160/90 Pulse: 114 RR: 18 Temp 98 Sat: 99 RA
General condition upon arrival in room: diaphoretic, flat affect, does not answer all questions but does answer appropriately when she chooses to, tired and intermittently follows command, does not remember what happened.
Would Intermittently Return to baseline function, persistent lack of recall. Persistent lack of concern for being admitted to hospital/apparent loss of function
Speech/language/cognition evaluation completed: pt presents with significant higher-level language processing deficits, particularly with orientation, memory (short-term, long-term, and immediate), and thought organization skills. Auditory comprehension is notably decreased as well, which impact’s pt’s ability to follow basic instructions or accurately respond to posed questions. Pt with highly inconsistent/erratic responses throughout evaluation, with significant language of confusion observed.
INITIAL LAB WORKUP
Mag: 2.2 Calcium: 9.1 Phos 3.8 UA Normal.
UDS: Neg for Barb, Benzo, Cocaine, Opiate, PCP No EtOH or Salicylate
TSH: 3.01 HbA1c: 5.6 Vit B12: 321 (nl) Trop <0.03
IMAGING:
CXR normal
CT + CTA of head and Neck: No intracranial hemorrhage, midline shift or mass effect.
2. No significant atherosclerotic change or narrowing in the extracranial carotids, vertebrobasilar arteries, or intracranial circulation.
- How does the repeat episode of confusion alter your differential diagnosis?
- What of the initial workup was high yield? Low yield?
- What labs and imaging would you like next?
Diagnosis is not the end, but the Beginning of Practice
Martin Fischer
