Differential diagnosis of atypical encephalopathy in critical care: a case report
- PDF / 2,387,282 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 25 Downloads / 233 Views
CASE REPORT
Open Access
Differential diagnosis of atypical encephalopathy in critical care: a case report Chung Li1, Ming-Yieh Peng2,3, Chia-Hui Chang3,4, Yuan-Yu Hsu3,5, Min-Shiau Hsieh6, Shinn-Kuang Lin3,7, Yi-Hsin Lee3,8 and Mei-Chen Yang3,9*
Abstract Background: A lower level of consciousness is a common presentation in critical care, with many different causes and contributory factors, of which more than one may be present concurrently. Case presentation: We described a woman with poorly controlled diabetes and steroid-dependent asthma who presented in a deep coma. She was found to have Streptococcus intermedius bacteremia and pyogenic ventriculitis that originated from right middle lobe pneumonia. Also, multiple small parenchymal lesions were observed on brain magnetic resonance imaging and increased protein concentration was noted in cerebral spinal fluid. Initially, her coma was thought to be due to diabetic ketoacidosis and septic encephalopathy. However, her lowered level of consciousness was disproportionate to either diabetic ketoacidosis or septic encephalopathy, and her clinical course was not as expected for these two conditions. Treatment with antibiotic, corticosteroid and antihelminthic drugs was administered resulting in improving consciousness. The Streptococcus intermedius pneumonia progressed to form a large cavity that needed an early surgical lobectomy and resulted in the unexpected diagnosis of chronic cavitary pulmonary aspergillosus. Conclusions: In critical care, a lowered level of consciousness may have many etiologies, and critical care clinicians should be familiar with the signs and symptoms of all possible causes to enable prompt diagnosis and appropriate treatment. Keywords: Neurocysticercosis, Encephalopathy, Pulmonary aspergillosis, Pyogenic ventriculitis, Streptococcus intermedius, Diabetic ketoacidosis
Background A lower level of consciousness is a common presentation in critical care. The most common contributing factors are stroke, post-anoxic coma, poisoning, and metabolic problems [1]. Many unconscious patients in critical conditions have more than one contributing factor on * Correspondence: [email protected] 3 School of Medicine, Tzu Chi University, Hualien, Taiwan 9 Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Rd, Xindian District, New Taipei 23143, Taiwan Full list of author information is available at the end of the article
admission. Unconsciousness due to diabetic ketoacidosis (DKA) induced by an infection or stroke is also common in critical care [2]. However, DKA alone occasionally causes a lowered level of consciousness, which usually resolves within 5 days after adequate treatment [3], but it may take up to 6 months to regain cognitive function [4]. Routine neuroimaging examinations for excluding stroke in patients with DKA are not cost-effective, unless patients have atypical neurological signs. Up to 70% of patients with septic encephalopathy experience v
Data Loading...
