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A lawyer with a drink problem
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
The patient’s condition can deteriorate and progress to delirium tremens (DT) which is diagnosed when the above symptoms are accompanied by altered mental state, e.g. confusion, hallucinations, and agitation.
Paediatrics
Published in Elizabeth Combeer, The Final FRCA Short Answer Questions, 2019
C: Intravenous access, ideally two cannulae. Obtain intraosseous access if intravenous access not immediately feasible. Assess for signs of shock: Capillary refill time greater than 2 seconds.Unusual skin colour.Tachycardia and/or hypotension.Cold hands/feet.Toxic/moribund state.Altered mental state/decreased conscious level.Poor urine output.
Wernicke-Korsakoff Syndrome
Published in Jenny Svanberg, Adrienne Withall, Brian Draper, Stephen Bowden, Alcohol and the Adult Brain, 2014
Scalzo Simon, Bowden Stephen, Hillbom Matti
In 1881, Carl Wernicke first described the encephalopathy that now bears his name. In his original article, he provided detailed descriptions of the clinical presentation and pathology of the disease (Wernicke, 1881, as translated in Thomson et al., 2008a). These initial observations have proved enduring, including the initial description of the “classic triad” of diagnostic signs. The classic triad, as currently conceived, consists of (i) oculomotor abnormalities, namely ophthalmoplegia and nystagmus, (ii) cerebellar dysfunction, especially gait ataxia, and (iii) altered mental state, ranging from subtle cognitive impairment to a global confusional state or coma (Caine et al., 1997; Galvin et al., 2010; Thomson et al., 2008a).
Listeria monocytogenes sepsis in the nursing home community: a case report and short review of the literature
Published in Acta Clinica Belgica, 2018
Griet Buyck, Veronique Devriendt, Anne-Marie Van den Abeele, Christian Bachmann
A retrospective observational study was conducted in Denmark by Thønnings et al. to investigate the clinical characteristics and risk factors for a fatal outcome with emphasis on the impact of the chosen antibiotic treatment [1]. All patients with Listeria monocytogenes isolated from blood or CSF cultures in a 15-year study period were identified, and the outcome was all-cause mortality within 30 days after the positive cultures were taken. 229 patients were included in the study cohort, and most patients were older people (mean age 71) or immunocompromised. The most frequent focus of infection was meningitis, followed by gastroenteritis, endocarditis, osteomyelitis, and septic arthritis. There was no significant difference in mortality between bacteremia and meningitis cases. However, the mortality rate was significantly higher in patients treated with inadequate empiric antibiotic therapy compared with patients treated with adequate empiric antibiotic therapy. Other significant risk factors for fatal outcome were altered mental state, septic shock, and low temperature. For the definitive antibiotic treatment, an increased mortality rate was seen in patients treated with meropenem compared with benzylpenicillin and aminopenicillins [1].
Deficits in saccades and smooth-pursuit eye movements in adults with traumatic brain injury: a systematic review and meta-analysis
Published in Brain Injury, 2018
Revathy Mani, Lisa Asper, Sieu K Khuu
TBI can be classified in terms of its severity, but its classification differs depending on the diagnostic scales/markers. On the GCS, a patient is considered to have mild TBI if the score is between 13–15, loss of consciousness is less than 30 minutes, and altered mental state and post-traumatic amnesia are less than 24 hours. Moderate TBI is diagnosed if GCS is between 9–12, altered mental state is greater than 24 hours, loss of consciousness is between 30 minutes and 24 hours, and post-traumatic amnesia between 1 and 7 days. Severe TBI is diagnosed when the scores on these tests are indicative of greater deficits: the GCS score is 3–8, altered mental state and loss of consciousness are greater than 24 hours and post-traumatic amnesia is greater than 7 days (1). Classification based on GCS score is useful for deciding further investigations in emergency departments, and does not necessarily relate to the extent of brain damage or to the prognosis or persistence of post-injury symptoms (6,7).
A devastating case of diarrhea-associated hemolytic uremic syndrome associated with extensive cerebral infarction; why we need to do better
Published in Acta Clinica Belgica, 2018
Werner Keenswijk, Evelyn Dhont, Ann Raes, An Bael, Johan Vande Walle
A 4-year-old girl was admitted to the pediatric ward with symptoms of bloody diarrhea, vomiting, fever, and reduced intake since 2 days. Her medical history was negative for underlying conditions while growth and development had been normal. She received IV fluid rehydration but 5 days later developed oliguria with laboratory analysis showing low hemoglobin (6.2 g/dl), thrombocytopenia (43 × 103/μL) with elevated serum creatinine (2.52 mg/dl) and urea (122 mg/dl). Fecal testing revealed enterohemorrhagic E.coli (STEC 157:H7) and verocytotoxins Type II confirming the diagnosis of D+HUS. Treatment with furosemide improved diuresis but repeated erythrocyte transfusions were necessary. On day 7, an altered mental state with confusion was noticed. In addition, a left hemiparesis and intermittent speech impairment were also present. A cerebral MRI showed edematous zones in the right parietal lobe. The patient was referred to our center for further treatment in view of this and the worsening of renal parameters.