1/19. Idiopathic pinealitis. Case report.This 63-year-old man presented with complaints of "having a feeling of falling backward" over a 3-month period. Results of his general physical examination, laboratory studies, and neurological examination were unremarkable. A magnetic resonance image revealed a 1.8 x 1.4 x 1.2-cm enhancing mass in the posterior third ventricle just above the corpora quadrigemina. The pineal gland was found to be diffusely enlarged at operation and separable from the posterior thalamus and was totally resected. The patient had an uneventful postoperative course but continues to be somewhat confused. The lesion consisted of a remarkable chronic inflammatory cell infiltrate permeating the pineal lobules and was composed of T and B lymphocytes, macrophages, eosinophils, and mast cells. Immunoperoxidase studies did not demonstrate langerhans cells, and a search for microorganisms was unrevealing. There was no evidence of neoplasia; results of immunostaining for germ cell markers and other tumor-associated antigens were negative.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/19. The many faces of confusion. Timing and collateral history often hold the key to diagnosis.Recognition of a patient's state of confusion is only the beginning of a clinical odyssey that can implicate a huge spectrum of diagnostic possibilities. Among these are delirium, depression, dementia, and sensory deprivation. However, with appropriate physical examination and laboratory studies, collateral history, and clarification of time course for the symptom complex, the cause of confusion need not remain confusing.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/19. confusion and dysphoria with low-dose topiramate in a patient with bipolar disorder.BACKGROUND: Topiramate, a newer antiepileptic agent, may benefit several neurological and psychiatric states, including bipolar disorder. CASE REPORT: A physically healthy, stockily built, 47-year-old, hypomanic Asian male with a >20-year history of uneventful use of psychotropic agents received topiramate in a dose that was stepped up to 100 mg/day across 10 days. He developed dysphoria, confusion, word-finding difficulties, and difficulties in maintaining a train of thought; the symptoms vanished within a week of drug discontinuation, and reappeared 1-2 days after rechallenge at a dose of 25 mg/day. CONCLUSION: It appears that, while confusion is usually a dose-dependent adverse effect of topiramate, certain patients may idiosyncratically develop this adverse effect at very low doses.- - - - - - - - - - ranking = 0.19543445866016keywords = physical (Clic here for more details about this article) |
4/19. confusion as the presenting manifestation of vertebral osteomyelitis: a case report.A 44-year-old patient presented with increasing confusion. He was first diagnosed as having intermittent pressure hydrocephalus but a further evaluation showed CSF pleocytosis and hypoglycorrhachia. Five weeks later, his physical examination was unrevealing. Nuclear imaging techniques were conflicting, with negative gallium- and indium-labelled white blood cells scans but a Tc scan pointing towards a vertebral infection. A well-demarcated lesion in the T9 vertebral body, demonstrated by CT scan, confirmed the diagnosis of vertebral osteomyelitis. Although we were unable to recover the causative organism, antibiotic treatment for presumed staphylococcal osteomyelitis resulted in full recovery. This case indicates that vertebral osteomyelitis may cause significant meningeal inflammation even in the absence of epidural or subdural abscess. We recommend that in patients with meningitis without a clear etiology vertebral osteomyelitis should be considered and pursued with CT scannings of the vertebrae, a procedure that can yield positive findings even when other scanning modalities are negative.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/19. Analyzing the traumatic impact of childhood visual impairment.Material is presented from three analyses involving the impact on adult functioning of childhood trauma to the visual system. The clinical process by which unrecognized but ongoing traumatic reactions are identified for subsequent analysis is described. It is of particular importance, with these patients, to recognize their lifelong experience of visual confusion resulting from problems in their visual anatomy. Only then can fantasies and affects related to these physically induced states of confusion be worked through. Working through these reactions promotes the neutralization of related primitive narcissistic affects, mourning, and realistic accommodation, and leads to a more intact and integrated sense of self, and a marked increase in self-esteem. With this newly integrated sense of self, the complex interaction between physically induced confusion states and more typical developmental conflicts with objects can be worked through, resulting in more realistic and intense cathexes of the external world. The trauma suffered by these patients had been greatly compounded by its having gone unrecognized. To miss this yet again in an analysis is to repeat the past and retraumatize the patient. These findings have clear implications for patients with other biologically related symptoms (e.g., ADD, ADHD, and dyslexia).- - - - - - - - - - ranking = 0.39086891732032keywords = physical (Clic here for more details about this article) |
6/19. BIPP madness; an iatrogenic cause of acute confusion.An 81-year-old man, admitted under the ear, nose and Throat Team with persistent epistaxis, developed an acute confusional state. He was previously physically independent and mentally competent. Immediate investigations did not reveal a cause for his deterioration. He eventually made a full recovery and returned home. Subsequently, his serum bismuth level was noted to be within the toxic range and was felt to have been the cause of his confusional state.- - - - - - - - - - ranking = 0.19543445866016keywords = physical (Clic here for more details about this article) |
7/19. Delayed neuropsychiatric impairment after carbon monoxide poisoning from burning charcoal.Poisoning by carbon monoxide from burning charcoal has become one of the popular and lethal ways of attempting suicide in hong kong. survivors of the carbon monoxide poisoning often face acute and delayed adverse problems in both their physical and mental health. We report two cases of delayed onset neuropsychiatric complications caused by carbon monoxide poisoning from burning charcoal. These symptoms were characterised by a latent period, followed by an abrupt and profound deterioration in the neurocognitive function with a seemingly reversible course. The literature is reviewed regarding the aetiology, pathophysiology, and management of this condition. Regular monitoring of their neurocognitive function and forewarning of this potential complication to the survivors of carbon monoxide poisoning and their families should be essential.- - - - - - - - - - ranking = 0.19543445866016keywords = physical (Clic here for more details about this article) |
8/19. cat-scratch disease: an unusual cause of combative behavior.Acute encephalitis is an unusual manifestation of cat-scratch disease. The authors present the case of a 27-year-old man who exhibited the acute onset of encephalitis manifested by violent behavior and confusion. The diagnosis of drug abuse was presumed initially, but a careful examination revealed the true cause to be cat-scratch disease. Emergency physicians are frequently faced with the challenging task of evaluating confused and combative patients. This case demonstrates the importance of a complete physical examination and a thorough laboratory evaluation.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/19. 'failure to thrive' in the elderly: diagnosis and management."failure to thrive" (FTT) is a term used to describe a gradual decline in physical and/or cognitive function of an elderly patient, usually accompanied by weight loss and social withdrawal, that occurs without immediate explanation. Both age-related and sociodemographic factors predispose the elderly to FTT. The most common etiologies are dementia, depression, delirium, drug reactions, and a few chronic diseases. The diagnostic evaluation of patients with FTT includes a review of the patient's activities of daily living, cognitive function, and mood; a targeted history and physical examination; and selected laboratory studies. Early recognition and management of FTT can reduce the risk of further functional deterioration, hospitalization, or nursing home placement.- - - - - - - - - - ranking = 1.1954344586602keywords = physical examination, physical (Clic here for more details about this article) |
10/19. Cystocerebral syndrome. Acute urinary retention presenting as confusion in elderly patients.The diagnosis of acute mental status changes in the elderly patient is often very difficult. Many causes are possible, and there is often little history obtainable. The physical examination occasionally provides the essential clues needed to discover the source of the sudden deterioration. We have recently evaluated four episodes of acute delirium in three elderly patients who presented with no readily apparent cause for these changes. On further evaluation, the patients were found to have marked bladder distention associated with acute urinary retention. None of these patients complained of discomfort, and none had any awareness or recollection of their deterioration. Each patient had rapid resolution of symptoms on bladder decompression. To our knowledge, this "cystocerebral syndrome" has not been previously described, and we suggest that it be considered in the evaluation of acute confusional states in elderly men.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
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