Episode 359: Neurology VMR – altered mental status
Oct 10, 2024
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Dr. Aaron Berkowitz, a neurologist, joins Aye Chan Moe Thant, a medical graduate from Myanmar dedicated to health equity, and Valeria Roldan, an aspiring neurologist from Peru. They dive into a captivating case of altered mental status, unraveling its complexities and diagnostic challenges. The discussion reveals intriguing links between upper respiratory infections and neurological conditions, as well as the nuances of autoimmune encephalitis. Ethical treatment considerations and advances in neurology showcase their passion for improving patient care in diverse contexts.
Altered mental status can stem from diverse neurological and systemic origins, highlighting the complexity of its diagnosis and treatment.
Differentiating between neurological and systemic causes is crucial, as systemic issues are often more prevalent in medical settings.
Collaboration between neurology and psychiatry is essential for accurate diagnosis and timely intervention in cases with overlapping symptoms.
Deep dives
Understanding Altered Mental Status
Altered mental status is a complex condition that can arise from various causes, including neurological and systemic disorders. Common neurological causes include seizures, strokes, and infections such as meningitis and encephalitis. Systemic conditions like metabolic imbalances, drug intoxication, and psychiatric diseases can also contribute significantly to altered mental status. Recognizing the diverse origins of this condition is crucial for proper diagnosis and treatment.
Differentiating Neurological and Systemic Causes
In evaluating altered mental status, the distinction between neurological and systemic causes is essential. Neurological causes tend to present as a result of direct brain involvement, while systemic causes are often associated with metabolic or toxicological factors. The likelihood of encountering a systemic cause generally surpasses that of a neurological cause, particularly in general medical settings. Nevertheless, neurologists frequently deal with patients referred for altered mental status who may have metabolic issues requiring careful assessment.
Case Study of a Young Woman
The podcast presented a case of a 30-year-old woman who experienced acute confusion and agitation following an upper respiratory infection. She exhibited psychiatric symptoms such as fear of dying, agitation, and hallucinations which complicate her diagnosis. Initial evaluations suggested potential infections impacting the brain, but her history and clinical presentation indicated a more complex condition potentially involving neuropsychiatric disorders. This highlights the need for thorough investigations, including comprehensive neurological assessments and discussions with psychiatry.
Diagnostic Challenges
The diagnosis of conditions like anti-NMDA receptor encephalitis remains intricate, especially when symptoms overlap with psychiatric disorders. Clinical presentations can mimic psychiatric illnesses in young adults, which can lead to misdiagnosis and inappropriate treatment. In this case, elevating the suspicion for autoimmune neurological conditions was vital as typical lab results returned negative. Neurology and psychiatry must collaborate closely to ensure accurate diagnoses and appropriate therapy for patients presenting with such ambiguous symptoms.
Emerging Insights into Autoimmune Encephalitis
Recent advancements in understanding autoimmune encephalitides, such as NMDA receptor encephalitis, underscore the importance of recognizing and diagnosing these conditions promptly. Treatment for these disorders often involves immunotherapy, and early recognition can lead to better patient outcomes. The podcast emphasized the necessity of considering underlying conditions like teratomas in female patients exhibiting autoimmune symptoms. It stresses that prompt identification, diagnosis, and therapeutic intervention can significantly improve recovery chances in patients affected by these evolving neurological disorders.
Episode title: Episode 359 Neurology VMR – altered mental status
Episode description: We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Vale presents a case of altered mental status to Aye.
Aye graduated from University of Medicine, Mandalay, Myanmar, and has been working with her mentor neurologist, one of only three neurologists covering the Upper Myanmar region of 23 million population. Through her experiences witnessing the challenges faced by patients in underserved areas and hearing their stories, Aye is dedicated to advancing health equity, global health initiatives, and various aspects of neurology, both in clinical practice and medical education. She is going to apply for a neurology residency program this year. Outside of work, she spends time playing piano, jogging along trails, and listening to music.
Valeria Roldan
@valeroldan23
Valeria Roldan was born and raised in Lima, Peru. She recently graduated medical school at Universidad Peruana Cayetano Heredia and is excited to pursue a career in Neurology. She is passionate about LGBTQ+ health, particularly advocating for trans rights, as well as medical education. She would describe herself as an optimist and outside of medicine you probably will find her running or talking about pop culture over a glass of wine.
