General

Case discussion - Confuse, confuse, confuse

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29 Aug 2016 - General
 

An elderly gentleman with background of atrial fibrillation on anticoaugualtion, previous colorectal cancer, hypertension , previous stroke, was admitted due to increasing in confusion, prodcutive cough for the last 1 week. His son reported patient became confusion every night and shouting for no appparent reason for the past week. Productive cough was started a week ago, and patient did had 3 falls recently as well prior to admission, the mechanic of fall was unclear as it was not witnessed by his son. Chest x-ray on admission showed right lower lobe consolidation and patient was given antibiotic. Why the patient get confuse ?? Is there any other investigation to be considered in this scenario ???

Thank you You Yi Hong my neurons are getting a good exercise again. :) Definitely we need to consider different possibilities and not just the ones we find to be obvious. Elder abuse may be another factor to consider despite being possibility presented with caring relatives. A multi-disciplinary team to act on this is a good option to further investigate the patient's problem and to give him well rounded care...
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Yes Mark Edmon Tan Jennifer Winter the most likely cause of his confusion or delirium will be secondary to his infection or pneumonia. But, given the fact that he has recurrent fall, and he is on anticoagulation (on warfarin with INR of 2.2 on admission), a CT-Brain should be performed at the time of admission to rule out potentia...
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Given an elderly male with several co-morbid conditions presenting with a cough and confusion would point to him having Pneumonia. Confusion is a common sign in the elderly with Pneumonia (indicating sepsis) and is one of the factors that prompts hospitalization. Though confusion accompanies such a scenarios often it is best to further investigate other possibilities as well while the patient is being treated for the infection. INR should be checked to see if anticoagulation is adequate, a head ...
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The case mentioned a history of 3 recent falls prior to admission. This was not investigated as no X-ray of the skull or cranial CT or MRI results was divulged. The leading cause of traumatic brain injury for adults is falls. Mild traumatic brain injury or concussion can result to this which may manifest as memory loss, poor concentration, impaired concentration, and even confusion. Postconcussive syndrome occurs when there is mild diagnosis with evidence of traumatic brain injury with imaging. ...
 (Total 110 words)