Case Presentation: A 38 year old thin, Native American female with no known past medical history presented to the hospital with combativeness, confusion and then obtundation. She was in her normal state of health according to her family and then developed confusion and erratic behavior at work. She had no history of seizures. She did [...]

Case Presentation: A 44 year old woman with a history of Roux-En-Y gastric bypass (RYGB), hypothyroidism, and morbid obesity, presented with one day of confusion and somnolence. In the emergency department, she was unresponsive to voice with an initial Glasgow Coma Score of 9. Her temperature was 94 F, pulse 94 beats per minute, blood [...]

Case Presentation: A 64-year-old female presented to the hospital with 2 days of nausea, vomiting, and diarrhea. She had no recent sick contacts, travel history, or antibiotic use. Her medical history was notable for Hereditary Hemorrhagic Telangiectasia (HHT) complicated by epistaxis refractory to medical and surgical interventions, bleeding gastric ulcers, pulmonary hypertension, and hepatic arteriovenous [...]

Case Presentation: 74-year-old male with history of NASH cirrhosis with Grade I esophageal variceal bleeding history, SDH s/p burr hole drainage with course complicated by seizures on Keppra and Vimpat, type 2 diabetes mellitus, and coronary artery disease status post 1 drug eluting stent who presented with worsening confusion, fatigue and difficulty walking x 3-4 [...]

Case Presentation: A 21-year-old previously healthy man presented to an outside hospital with one day of confusion without any other localizing symptoms. He reported taking a supplement called Synergy, an androgen receptor modulator, for six months, and doxylamine, a first generation anti-histamine, for one-two days. He denied alcohol consumption or other substances. Initial vital signs [...]

Case Presentation: A 75-year-old man presents with altered mental status for one day. On exam, patient was nonverbal, opening eyes spontaneously, and responsive to painful stimuli. CT head, chest x-ray, urinalysis, blood cultures, urine cultures, metabolic panel, blood counts, and toxicology screen were all not significant for acute findings.The patient has a history of stage [...]

Case Presentation: A 78-year-old female with a history of breast cancer and pancreatic cancer, with status post Whipple procedure and started with capecitabine one month prior to admission, severe malnutrition, started on a high-protein diet one month prior, presented with acute encephalopathy. Her symptoms started acutely as confusion, then progressed to somnolence. She was alert [...]

Case Presentation: 46-year-old lady with past medical history of polysubstance abuse, seizures, HIV on treatment, mood disorder on quetiapine/valproic acid was brought to hospital by a family member for drowsiness. They reported that she has been drowsy since one week and had history of recent heroin use. Patient intermittently awake could give history of her [...]

Case Presentation: We present a case of a 55-year-old Caucasian woman with a history of hypothyroidism, anxiety, depression, burns affecting 70% of body area (sustained in a motor vehicle accident 4 months before this admission), and recent COVID-19 infection, who presented for altered mental status. She was noted to be less conversive than baseline and [...]

Case Presentation: 44-year-old male with a history of seasonal allergies presented with subacute mental status and behavior changes, malaise, and decreased oral intake after elective nasal polypectomy. Following polypectomy, he was started on a nasal steroid and antibiotics. Local ED determined symptoms possibly due to recent surgery. IVF and PO glucose provided temporary symptom relief. [...]