Chief complaint: altered mental status
Quick reasoning on
Altered mental status
potential causes
Systemic
Neurologic
Psychiatric
Most of the patients
Localization Time course
Metabolic
Toxic
Brain Brainstem
Hemorrhagic >> ischemic stroke
Sudden
Other
Acute
Meningitis, encephalitis
You can also remember the MIST mnemonic: Metabolic, Infection, Structural, Toxin
Subacute
Limbic encephalitis, expanding mass lesion, multifocal lesions
Acute/subacute psychiatric symptoms
Young woman
HPI: 30 year old woman that presented to the ED with acute confusion, agitation and fear of dying. Her partner refers that for the last 2 days she has grown increasingly worried of dying, apart of being aggresive, agitated and talking alone. A week ago she had an URI while in a trip to the north of Perú
potential causes
Infection: HSV encephalitis
Demyelinating: ADEM Autoimmune: anti-NMDA encephalitis Toxic, metabolic
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