A Review of Rare Etiologies of Altered Mental Status in the Emergency Department

Douglas VC, Josephson SA. Altered mental status. Continuum (Minneap Minn) 2011;17(5 Neurologic Consultation in the Hospital):967–83. (In eng).

•• Kim KT, Jeon JC, Jung C-G, Park JA, Seo J-G, Kwon DH. Etiologies of altered level of consciousness in the emergency room. Sci Rep. 2022;12(1):4972. https://doi.org/10.1038/s41598-022-09110-2. In this retrospective study of 2028 patients presenting to a single center with altered levels of consciousness, nearly two-thirds of patients were found to have either an infectious, metabolic or stroke as the etiology of altered mental status and 7% of patients had an undetermined etiology of altered mental status despite investigations in the ED.

Fitzgerald FT, Tierney LM, Wall SD. The comatose patient. Postgrad Med. 1983;74(1):207–15. https://doi.org/10.1080/00325481.1983.11697914.

CAS  Article  PubMed  Google Scholar 

Nicholl DJ, Appleton JP. Clinical neurology: why this still matters in the 21st century. J Neurol Neurosurg Psychiatry 2015;86(2):229–33. (In eng). https://doi.org/10.1136/jnnp-2013-306881.

Baker AM, Yasavolian MA, Arandi NR. Nonconvulsive status epilepticus: overlooked and undertreated. Emerg Med Pract. 2019;21(10):1–24 (In eng).

Kinney MO, Craig JJ, Kaplan PW. Non-convulsive status epilepticus: mimics and chameleons. Pract Neurol 2018;18(4):291–305. (In eng). https://doi.org/10.1136/practneurol-2017-001796.

Meierkord H, Holtkamp M. Non-convulsive status epilepticus in adults: clinical forms and treatment. Lancet Neurol 2007;6(4):329–39. (In eng). https://doi.org/10.1016/s1474-4422(07)70074-1.

Hoyer C, Szabo K. Pitfalls in the diagnosis of posterior circulation stroke in the emergency setting. Frontiers in Neurology 2021;12 (Review) (In English). https://doi.org/10.3389/fneur.2021.682827.

Martin-Schild S, Albright KC, Tanksley J, et al. Zero on the NIHSS does not equal the absence of stroke. Ann Emerg Med 2011;57(1):42–5. (In eng). https://doi.org/10.1016/j.annemergmed.2010.06.564.

Alemseged F, Rocco A, Arba F, et al. Posterior national institutes of health stroke scale improves prognostic accuracy in posterior circulation stroke. Stroke 2022;53(4):1247–1255. (In eng). https://doi.org/10.1161/strokeaha.120.034019.

Gurley KL, Edlow JA. Avoiding misdiagnosis in patients with posterior circulation ischemia: a narrative review. Academic Emergency Medicine 2019;26(11):1273–1284. (https://doi.org/10.1111/acem.13830). https://doi.org/10.1111/acem.13830.

Searls DE, Pazdera L, Korbel E, Vysata O, Caplan LR. Symptoms and signs of posterior circulation ischemia in the new England medical center posterior circulation registry. Arch Neurol 2012;69(3):346–51. (In eng). https://doi.org/10.1001/archneurol.2011.2083.

Miller JB, Suchdev K, Jayaprakash N, et al. New developments in hypertensive encephalopathy. Curr Hypertens Rep 2018;20(2):13. (In eng). https://doi.org/10.1007/s11906-018-0813-y.

• Mergen S, Long B, Matlock A. Posterior reversible encephalopathy syndrome: a narrative review for emergency clinicians. The Journal of Emergency Medicine 2021;61(6):666–673. https://doi.org/10.1016/j.jemermed.2021.09.005. This is a narrative review article providing a comprehensive overview of the risk factors, presentation, and management of PRES.

Lee VH, Wijdicks EF, Manno EM, Rabinstein AA. Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Arch Neurol 2008;65(2):205–10. (In eng). https://doi.org/10.1001/archneurol.2007.46.

Fugate JE, Claassen DO, Cloft HJ, Kallmes DF, Kozak OS, Rabinstein AA. Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin Proc 2010;85(5):427–32. (In eng). https://doi.org/10.4065/mcp.2009.0590.

Hobson EV, Craven I, Blank SC. Posterior reversible encephalopathy syndrome: a truly treatable neurologic illness. Perit Dial Int 2012;32(6):590–4. (In eng). https://doi.org/10.3747/pdi.2012.00152.

Wandinger KP, Saschenbrecker S, Stoecker W, Dalmau J. Anti-NMDA-receptor encephalitis: a severe, multistage, treatable disorder presenting with psychosis. J Neuroimmunol 2011;231(1–2):86–91. (In eng). https://doi.org/10.1016/j.jneuroim.2010.09.012.

Tuzun E, Dalmau J. Limbic encephalitis and variants: classification, diagnosis and treatment. Neurologist 2007;13(5):261–71. (In eng). https://doi.org/10.1097/NRL.0b013e31813e34a5.

Gultekin SH, Rosenfeld MR, Voltz R, Eichen J, Posner JB, Dalmau J. Paraneoplastic limbic encephalitis: neurological symptoms, immunological findings and tumour association in 50 patients. Brain 2000;123 ( Pt 7):1481–94. (In eng). https://doi.org/10.1093/brain/123.7.1481.

Graus F, Saiz A. Limbic encephalitis: a probably under-recognized syndrome. Neurologia. 2005;20(1):24–30 (In spa).

Salvarani C, Brown RD Jr, Hunder GG. Adult primary central nervous system vasculitis. The Lancet. 2012;380(9843):767–77. https://doi.org/10.1016/S0140-6736(12)60069-5.

Article  Google Scholar 

Suzuki J, Kodama N. Moyamoya disease--a review. Stroke 1983;14(1):104–9. (In eng). https://doi.org/10.1161/01.str.14.1.104

• Sinha S, Kataria A, Kolla BP, Thusius N, Loukianova LL. Wernicke Encephalopathy-Clinical Pearls. Mayo Clin Proc. 2019;94(6):1065–72. https://doi.org/10.1016/j.mayocp.2019.02.018This review article highlights the pathophysiology, presentation, and management of various thiamine deficiency disorders. Notably, the classic triad of confusion, ophthalmoplegia and ataxia is present in around 10% of patients with Wernicke’s encephalopathy.

Donnino MW, Vega J, Miller J, Walsh M. Myths and misconceptions of Wernicke’s encephalopathy: what every emergency physician should know. Ann Emerg Med 2007;50(6):715–21. (In eng). https://doi.org/10.1016/j.annemergmed.2007.02.007.

Smithline HA, Donnino M, Greenblatt DJ. Pharmacokinetics of high-dose oral thiamine hydrochloride in healthy subjects. BMC Clin Pharmacol. 2012;12:4. https://doi.org/10.1186/1472-6904-12-4.

CAS  Article  PubMed  PubMed Central  Google Scholar 

Dunkley EJ, Isbister GK, Sibbritt D, Dawson AH, Whyte IM. The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity. Qjm 2003;96(9):635–42. (In eng). https://doi.org/10.1093/qjmed/hcg109.

Levenson JL. Neuroleptic malignant syndrome. Am J Psychiatry. 1985;142(10):1137–45. https://doi.org/10.1176/ajp.142.10.1137.

CAS  Article  PubMed  Google Scholar 

Ferracci F, Bertiato G, Moretto G. Hashimoto’s encephalopathy: epidemiologic data and pathogenetic considerations. J Neurol Sci 2004;217(2):165–8. (In eng). https://doi.org/10.1016/j.jns.2003.09.007.

Kirshner HS. Hashimoto's encephalopathy: a brief review. Curr Neurol Neurosci Rep 2014;14(9):476. (In eng). https://doi.org/10.1007/s11910-014-0476-2.

Hanna FWF, Issa BG, Kevil B, Fryer AA. Investigating cortisol excess or deficiency: a practical approach. Bmj 2019;367:l6039. (In eng). https://doi.org/10.1136/bmj.l6039.

Ropper AH. Neurosyphilis. N Engl J Med 2019;381(14):1358–1363. (In eng). https://doi.org/10.1056/NEJMra1906228.

Eggers C, Arendt G, Hahn K, et al. HIV-1-associated neurocognitive disorder: epidemiology, pathogenesis, diagnosis, and treatment. J Neurol 2017;264(8):1715–1727. (In eng). https://doi.org/10.1007/s00415-017-8503-2.

Health NIo. Whipple disease. 12/8/2015 (https://rarediseases.info.nih.gov/diseases/7889/whipple-disease).

Louis ED, Lynch T, Kaufmann P, Fahn S, Odel J. Diagnostic guidelines in central nervous system Whipple’s disease. Ann Neurol 1996;40(4):561–8. (In eng). https://doi.org/10.1002/ana.410400404.

Geschwind MD. Prion Diseases. Continuum (Minneap Minn) 2015;21(6 Neuroinfectious Disease):1612–38. (In eng). https://doi.org/10.1212/con.0000000000000251.

Berger JR, Aksamit AJ, Clifford DB, et al. PML diagnostic criteria: consensus statement from the AAN neuroinfectious disease section. Neurology 2013;80(15):1430–1438. (In eng). https://doi.org/10.1212/WNL.0b013e31828c2fa1.

Kessler CS, Khan BA, Lai-Miller K. Thrombotic thrombocytopenic purpura: a hematological emergency. J Emerg Med 2012;43(3):538–44. (In eng). https://doi.org/10.1016/j.jemermed.2012.01.027.

Chiasakul T, Cuker A. Clinical and laboratory diagnosis of TTP: an integrated approach. Hematology Am Soc Hematol Educ Program 2018;2018(1):530–538. (In eng). https://doi.org/10.1182/asheducation-2018.1.530.

O'Malley R, Rao G, Stein P, Bandmann O. Porphyria: often discussed but too often missed. Pract Neurol 2018;18(5):352–358. (In eng). https://doi.org/10.1136/practneurol-2017-001878.

Graus F, Dalmau J. Paraneoplastic neurological syndromes in the era of immune-checkpoint inhibitors. Nat Rev Clin Oncol 2019;16(9):535–548. (In eng). https://doi.org/10.1038/s41571-019-0194-4.

Dalmau J, Rosenfeld, MR. Paraneoplastic and autoimmune encephalitis. UpToDate. 7/8/2022 (https://www.uptodate.com).

Hayashi Y, Inuzuka T. Paraneoplastic neurological syndrome and autoantibodies. Brain Nerve. 2013;65(4):385–93 (In jpn).

Hyun JW, Jeong IH, Joung A, Cho HJ, Kim SH, Kim HJ. Leptomeningeal metastasis: clinical experience of 519 cases. Eur J Cancer 2016;56:107–114. (In eng). https://doi.org/10.1016/j.ejca.2015.12.021.

Clarke JL, Perez HR, Jacks LM, Panageas KS, Deangelis LM. Leptomeningeal metastases in the MRI era. Neurology 2010;74(18):1449–54. (In eng). https://doi.org/10.1212/WNL.0b013e3181dc1a69.

Morton A. Imitators of preeclampsia: a review. Pregnancy Hypertens 2016;6(1):1–9. (In eng). https://doi.org/10.1016/j.preghy.2016.02.001.

Vivaldo JF, de Amorim JC, Julio PR, de Oliveira RJ, Appenzeller S. Definition of NPSLE: does the ACR nomenclature still hold? Frontiers in Medicine 2018;5 (Review) (In English). https://doi.org/10.3389/fmed.2018.00138.

Carrión-Barberà I, Salman-Monte TC, Vílchez-Oya F, Monfort J. Neuropsychiatric involvement in systemic lupus erythematosus: a review. Autoimmun Rev 2021;20(4):102780. (In eng). https://doi.org/10.1016/j.autrev.2021.102780.

The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis & Rheumatism 1999;42(4):599–608. https://pubmed.ncbi.nlm.nih.gov/10211873/

Finelli PF, Inoa V. Limbic encephalitis as the presenting feature of Sjögren syndrome. Neurol Clin Pract 2013;3(2):165–167. (In eng). https://doi.org/10.1212/CPJ.0b013e31828d9f81.

Delalande S, de Seze J, Fauchais AL, et al. Neurologic manifestations in primary Sjögren syndrome: a study of 82 patients. Medicine (Baltimore) 2004;83(5):280–291. (In eng). https://doi.org/10.1097/01.md.0000141099.53742.16.

留言 (0)

沒有登入
gif