“Not your typical ‘altered mental status’ consult.”
Mrs. KD is a 49-year-old woman with a history of alcohol abuse admitted for evaluation of encephalopathy. For several days prior to presentation, family had noticed that the patient was progressively confused and eating much less than usual.
Neurology was consulted for altered mental status. Upon initial evaluation, the patient was hypothermic (32°C). She was cachectic, somnolent, disoriented to time, and had difficulty following multi-step commands. She demonstrated mild bilateral ataxia with finger-to-nose test and multi-directional nystagmus with extraocular movements.
Labs were remarkable for hypernatremia (Na 156) and pre-renal azotemia (BUN 44, Cr 1.3).
CT head without contrast was unremarkable.
An MRI brain (with and without contrast) was obtained. Select images from the T2/FLAIR sequence are shown.
(Diagnosis will be posted next week)
Zach Rohm, M.D. Jenny Joseph, M.D.
Emory Neurology PGY-3 Emory Neurology PGY-2