The Clinical Problem Solvers Episode 402: Neurology VMR – AMS
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Jun 19, 2025 In this engaging discussion, Bayan Al Zoabu, a passionate senior medical student from Syria known for her work in neurology and ethics, presents a case of a 71-year-old woman with altered mental status to Dr. Aye Chan Moe Thant, a dedicated neurologist focused on health equity. They dive into the complexities of diagnosing conditions like dementia and meningitis, the significance of lumbar punctures, and the essential role of thorough assessments in neurology. They also discuss the neurological implications of autoimmune disorders, revealing the intricacies of patient care.
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Framework for Altered Mental Status
- Altered mental status can be broadly categorized into medical, neurologic, and psychiatric causes.
- Time course (hyperacute, acute, subacute, chronic) is crucial for narrowing neurologic diagnoses.
Examining Confused Patients
- In altered mental status, assess if the patient is awake and able to follow commands.
- Examine cranial nerve reflexes, motor response symmetry, and look for meningismus signs even if patient is uncooperative.
Pain and Zoster Link to Encephalitis
- Pain can cause altered mental status or delirium, especially in elderly dementia patients.
- Herpes zoster rash with pain and neurologic symptoms suggests possible zoster meningitis or encephalitis.
