Slideshow: Presentations of Altered Mental Status

  • Welcome to our latest slideshow! Click through the slides to learn about different presentations and causes of altered mental status. Each slide links to the full case report for more details.

  • Ganciclovir-Resistant Cytomegalovirus Encephalitis in a Patient With AIDS

    A 52-year-old woman with AIDS with a CD4 cell count of 30/µL presented with altered mental status and failure to thrive. Because she was slow to speak and somnolent, it was difficult to obtain information from a review of systems, other than the fact that she had experienced decreased oral intake and confusion. This change in mental status had recently been noted by her family members shortly after she had begun outpatient ART.

    Read the full case report here.

  • Neuropsychiatric Systemic Lupus Erythematosus: A Teenager With Acute Agitation and Altered Mental Status

    A 19-year-old African American young adult with systemic lupus erythematosus (SLE) presented to the emergency department with acute agitation and altered mental status. She had received a diagnosis of SLE 4 years previously, but she had not experienced any episodes of altered mental status since that time. She presented with agitation, including yelling, singing, and talking gibberish. This was followed by an inability to follow commands and unintelligible responses to questions. She was highly combative and required three 5-mg doses of midazolam and one 5-mg dose of haloperidol to calm her.

    Read the full case report here.

  • A 15-Year-Old Girl With Anti-NMDA Encephalitis With Extreme Delta Brush on Electroencephalography

    A 15-year-old girl with no significant medical history presented to a local community hospital with a 1-day history of altered mental status. She initially had had a fever (temperature to 38°C) with cough and rhinorrhea. Two days later, she became anxious, fidgety, and clumsier than usual. Her parents became concerned when the girl began to have “strange and vivid dreams,” such as believing she had won the lottery.

    Read the full case report here.

  • Miller-Fisher Syndrome

    A 39-year-old woman presented to the emergency department with altered mental status, ophthalmoplegia, paroxysms of extremity weakness associated with progressive ataxia, and diminished lower extremity reflexes over the past 8 days. When further prompted, the patient reported that she had had a “chest infection” 1 month prior. She denied any recent travel and stated that she had gone out for a walk the previous month and had gotten a cold, for which she was hospitalized for 4 days. The patient also stated that for the past few weeks, she had started “walking funny” and bumping into furniture, a symptom that had been progressively worsening despite no association with pain, change in urine color, activity, or use of new medication.

    Read the full case report here.

  • Posterior Reversible Encephalopathy Syndrome in a Patient With Hypertension on Oral Methotrexate Therapy

    An 86-year-old woman presented to our institution from an outside hospital for management of altered mental status. She had a history of B-cell lymphoma, for which she had received radiation therapy; rheumatoid arthritis, for which she was on methotrexate; a history of multiple unprovoked venous thromboemboli, for which she was on warfarin; and hypertension. At initial presentation, the patient was unable to provide any meaningful history, given her encephalopathic state; therefore, most of her history was obtained from family. The patient reportedly had been functioning independently in her living facility—completing her activities of daily living with minimal assistance and being oriented and appropriate in her mentation. However, in the 2 weeks prior to presentation at the outside hospital, the patient had experienced 3 falls.

    Read the full case report here.