TY  - CHAP
M1  - Book, Section
TI  - Encephalopathy and Delirium
A1  - Edwards, Nancy J.
A1  - Lee, Kiwon
A2  - Lee, Kiwon
Y1  - 2017
N1  - 
T2  - The NeuroICU Book, 2e
AB  - A  46-year-old  man  with  a  history  of  idiopathic  hypoparathyroidism  presented  to  the  emergency  department  with  “altered  mental  status.”  His  wife  described  the  patient  as  having  been  restless  and  irritable  for  several  days,  and  then  he  became  quite  confused—mumbling  words  and  barely  speaking  to  her.  Neurologic  examination  revealed  an  alert  but  restless  and  inattentive,  nonverbal  man  who  was  able  to  follow  certain  simple  commands  but  required  significant  encouragement  in  order  to  do  so.  Cranial  nerve  examination  was  notable  for  fine  nystagmus  that  was  present  nearly  continuously,  even  in  primary  gaze.  The  motor  examination  was  nonfocal  other  than  the  absence  of  deep  tendon  reflexes  in  the  bilateral  lower  extremities.  A  computed  tomography  (CT)  scan  was  performed  and  did  not  reveal  any  acute  findings.  His  laboratory  results  were  primarily  notable  for  a  serum  calcium  of  4.1  mg/dL  and  an  albumin  of  3.4  gm/dL.  Intravenous  (IV)  calcium  supplementation  was  initiated,  and  the  patient  was  admitted;  an  endocrinologist  was  called  for  further  recommendations.  The  patient’s  astute  admitting  physician  also  ordered  an  electroencephalogram  (EEG),  given  the  patient’s  hypocalcemia,  severe  encephalopathy,  and  the  fine,  continuous  nystagmus  noted  on  examination.  The  EEG  was  suggestive  of  nonconvulsive  status  epilepticus.  The  patient  was  given  2  mg  of  IV  lorazepam  that  resulted  in  a  cessation  of  epileptiform  activity  on  the  EEG.  Within  minutes,  he  began  speaking  again,  and  within  hours  he  was  nearly  recovered  in  terms  of  his  encephalopathy.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/18
UR  - neurology.mhmedical.com/content.aspx?aid=1143954824
ER  -