Patient developed altered sensorium on 5th day of fever. A 48yearold housewife presented with a history of fever for 5 days followed by headache and altered sensorium for 3 days. At the time of our assessment, the patient was too altered. Early recognition, efficient decision making and rapid institution of therapy can be life saving. Introduction a patient with fever and altered sensorium constitutes a medical emergency. Acute febrile encephalopathy in adults from northwest india ncbi. The etiological diagnosis and outcome in patients of acute febrile. After followup, mean total duration of fever in survivors was found to be 14. Dengue encephalitisa rare manifestation of dengue fever. A patient presenting with fever and altered sensorium constitutes a medical emergency. Altered sensorium in scrub typhus article pdf available in journal of postgraduate medicine 573. The results of a portable chest radiograph are normal. He developed seizures in the emergency department and was in a state of shock. Level of consciousness loc is a measurement of a persons arousability and responsiveness to stimuli from the.
Acute onset fever with altered mentation is a common problem encountered by. A simple discussion of these causes with additional information is below. A complicated case of altered sensorium mahe digital. Recognize the importance of historical factors in diagnosing causes of as identify dementia, delirium. We report a case of 20 years old girl who presented with catatonia resulting from cerebral lupus. An altered level of consciousness is any measure of arousal other than normal.
Altered mental status ams is a general term used to describe various disorders of mental functioning ranging from slight confusion to coma. Acute encephalitis syndrome with an unusual diagnosis. Fouryear old boy presented with history of fever for 2 days and sudden onset of altered sensorium and 1 episode of seizure on day 2 of fever. Fever, jaundice, altered sensorium, with multiple systemic manifestations article pdf available in indian journal of gastroenterology 262. Emergency clinicians need to accurately diagnose and administer timely. Sensorium can be clear as well as functioning normally or clouded and it means we cannot con. Clinically, it may be difficult to differentiate between the two, except for that the focal neurological complications are more common with central nervous system cns tuberculosis than with cerebral malaria. Signs and symptoms associated with altered mental status ams include confusion, amnesia, poor judgment, and poor regulation of emotions. A study on clinical presentation of dengue fever in children. Lupus catatonia in a young girl who presented with fever. Mr imaging in biphasic japanese encephalitis american.
A 62yearold male known case of systemic hypertension on regular antihypertensive medications, also a chronic smoker and alcoholic presented with sudden onset altered sensorium. Axial top left and coronal bottom left t2weighted flair mr images show the sites of infection as increased signal intensity in the right insular. There was no history of use of any prescription drugs. A case series on the recent nipah epidemic in kerala.
It is usually synonymous with, or substantially overlapping with, altered. Pdf fever, jaundice, altered sensorium, with multiple. Introduction a patient with fever and altered sensorium. Dr prabhu, we have a 4 year old boy from dadar, mumbai admitted now to the picu with complaints of fever since 5 days and altered sensorium since 1 day. With the advent of increasing number of noninfectious causes, especially autoimmune encephalitis, the diagnostic workup of patient with encephalopathy is ever growing and so are the management options.
Fever due to underlying infection is common, and signs of acidosis kussmaul respiration, acetone breath are usually absent. Other im portant elements of the history include symptoms of infection such as fever. Patient was having his dinner when he collapsed suddenly and was in an unresponsive state. He was born full term by caesarean section with the birth weight of 2. There are few cases of catatonia being described in systemic lupus erythmatoses sle. Fever with altered mental state commonly results from bacterial meningitis, japanese b. Additional history and laboratory findings reveal the diagnosis. The patient presented to us with fever and altered sensorium. Capnocytophaga canimorsus infection is the most severe and rapidly progressive bacterial infection transmitted by dog bite and fortunately is very rare. Involvement of the central nervous system in dengue fever. Approach to a case of fever with altered sensorium slideshare. Altered mental status is a term used for a range of presentations sudden or gradual changes in behaviour disorientation confusion coma may be due to conditions that affect the brain or the brain itself. There was no family history of any significant illnesses.
The following medical conditions are some of the possible causes of altered sensorium. This information shows the various causes of altered sensorium, and how common these diseases or conditions are in the general population. There was no history of bleeding from any site during presentation, no history of cough. Request pdf fever with altered sensorium any patient presenting in altered sensorium poses a diagnostic and therapeutic challenge for the treating. If the patient survives, there is gradual recovery with or without persistent signs of central nervous system. This section discusses 14 medical conditions causing altered sensorium. A 16yearold boy presented to our institute with a history of fever, headache, body ache, and occasional vomiting for 14 days and altered sensorium for a day before admission. Some patients are asymptomatic or have only mild fever. She did not have any significant premorbid illnesses or addictions. The patient had the classic triad of fever, nuchal rigidity, and altered mental status that is characteristic of meningitis. Hawkins j, wilson a, mcwilliams e emerg med j, 2812. A 33yearold woman presented with fever for 10 days, jaundice for 2 days, altered sensorium for 2 days, and decreased urine output for 1 day. A 56yearold man presented to the emergency department with a 5day history of altered mental status, fever, and abdominal pain. Systemic inquiry revealed psychosocial withdrawal, decreased oral intake, minimal speech and inability to move.
Fever with altered sensorium shilanjan roy dept of medicine burdwan medical college 2. We report the case of a 48yearold woman who presented with a history of fever and altered sensorium of short duration. Development of symptoms such as tachypnea, shaking chills, persistent fever, altered sensorium, hypotension, and gi symptoms abdominal pain. The most common symptom in children who had neurological manifestations was fever 100%, followed by altered sensorium. The reason for altered sensorium in meningitis is postulated to be the spillage of inflammatory cells to the. Fever with altered sensorium request pdf researchgate. A 20 year old girl presented with one week history of high grade fever and altered sensorium. The etiological diagnosis and outcome in patients of acute. This is not a direct indication as to how commonly these diseases are the actual cause of altered sensorium. Patient had diffuse type headache from onset of fever itself.
Given the vagueness of the term, it is imperative to understand. Any patient presenting in altered sensorium poses a diagnostic and therapeutic challenge for the treating physician. In this study we have made an attempt to describe the variety of clinical presentation of dengue fever. With the advent of increasing number of noninfectious causes. Such presentation is very commonly seen in outpatient. Fever with altered sensorium shilanjan roy dept of medicine burdwan. A 7yearold boy presents to the busy ed in india with a 1day history of abnormal behavior, generalized seizures, and altered sensorium. Sensorium definition of sensorium by the free dictionary. The reason for altered sensorium in meningitis is postulated to be the spillage of inflammatory cells to the adjacent brain parenchyma and the resultant parenchymal involvement.
She also had abnormal movement of head and both upper limbs and vomiting episodes along with altered sensorium. A clouded sensorium, also known as an altered sensorium, is a medical condition characterized by the inability to think clearly or concentrate. Read about causes of altered mental status and the medications used in treatment. A 49yearold gentleman presented with fever, altered sensorium. Approach to a child with altered sensorium dd authorstream. We report an interesting case of dengue encephalitis from southern india. We report the case of a 48yearold woman who presented with a history of fever and altered sensorium. Changing clinical manifestations of dengue infection in. Clinicopathology conference fever, jaundice, altered. Patients presenting with fever and altered sensorium should be treated as a medical emergency. Fulminant hepatic failure in primary dengue infection. Causes of altered sensorium causes of altered sensorium.
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