Background: Altered mental status (AMS) is prevalent in hospitalized patients, especially the elderly (1). The work up of AMS is based on history, physical exam, pertinent labs and imaging. Common etiologies include fluid and electrolyte disturbances, infections, drug toxicity, drug withdrawal and metabolic derangements. Many routine labs drawn in the evaluation of acute encephalopathy are [...]

Altered Mental Status in a Psychiatric Patient: A Case of Anti-NMDA Encephalitis Case Presentation: 29-year-old female with a history of Bipolar I Disorder, in remission off medication, presented to the Psychiatric Emergency Department with hyperactivity, insomnia, impulsive purchasing and audiovisual hallucinations for two weeks. The patient was admitted to psychiatry for treatment of mania with [...]

Background: CT Head imaging for patients with altered mental status is a common procedure that many clinicians utilize to establish a diagnosis. As health care costs rise, practitioners are becoming more conscious about ordering costly imaging studies that are unlikely to change management. The purpose of the study is to determine when obtaining CT imaging [...]

Case Presentation: A 19-year-old Caucasian female with hypothyroidism on synthroid was transferred from an outside emergency department for evaluation of psychosis. The patient’s father first noted changes in her behavior several months prior to admission when she developed rapid onset of excessive cleaning and organizing behavior, which was inconsistent with her prior messy behavior.  In [...]

Case Presentation: A 44-year-old male presented to the emergency department with a 2 hour history of altered mental status. His wife reports that when he awoke, he was confused and acting inappropriately. After no improvement for 2 hours he was brought to the ED. En route to the ED, he ate a Hershey chocolate bar [...]

Case Presentation: 57-year-old male, with history of recurrent idiopathic hypothermic episodes, HFrEF on carvedilol, T2DM on no medication for 3 months, and stage 4 CKD, presented to the ED for altered mentation. Vitals were unremarkable except for hypothermia (86.4°F). Patient was hypoglycemic (62 mg/dL). WBC count was low (1.26 10^3/uL). Urine WBCs were elevated (31-50/HPF). [...]

Case Presentation: A 81 year-old Caucasian male presented to the emergency department with fever and altered mental status for two days. Further chart review revealed history of nausea, vomiting, myalgias, abdominal pain, and unintentional 35 pound weight loss over the six months prior. At the time of admission the patient was lethargic, febrile and tachycardic. [...]

Case Presentation: 41 year old male with a history of substance use (Phencyclidine/PCP) was brought to the hospital after being found nude and unconscious outside for an unknown period. At presentation he was awake but mute, not following commands nor tracking with his eyes. He was intermittently agitated. Exam notable for fever 103F, heart rate [...]

Case Presentation: A 62 year old woman with a history of hypertension suddenly developed a headache starting 3 days after receiving the influenza vaccine. The headache worsened and was associated with nausea, photosensitivity and vomiting. The next day she was lethargic, and that night, her husband states she sat up in bed and started “speaking [...]

Case Presentation: An 85-year-old female presented to the ED with a chief concern of altered mental status from her previous baseline cognitive status a few hours prior. The patient’s medical history was significant for dementia, type 2 diabetes mellitus, and hypothyroidism. Initial exam revealed a confused but cooperative patient, A&Ox2 (self and time), discoloration of [...]