82 year old man

Introduction

• SN is an 82 yo gentleman who presents with family members, wife & son with complaints of worsening mental status over the past 3 months.
• Visual hallucinations have been noted (the family dog given as the only example) as well as delusions.
• He recently referred to his only son by another name.
• He constantly talks of the past.
• Occasionally he is aware of what is going on in the present.
• His wife & son are very stressed and say it is difficult to care for him at home.

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• For the past 2 months, the patient has been in a wheel chair because of multiple falls.
• He had been using a walker prior tothat but apparently fell despite the walker.
• Today he notes knee pain that had been evaluated at an outside ER where they gave him Vicodin, but this only worsened the hallucinations.

History

• Past Medical History:
  • Coronary artery disease, s/p stent placement
  • diabetes mellitus type 2
  • hypercholesterolemia
  • hypertension
  • benign prostatic hypertrophy
  • hearing loss
  • depression
  • seizure disorder (seizure 1 year prior to admission)
  • left wrist fracture secondary to fall
  • meningioma 30 years ago (surgical resection, no radiation)
  • history of deep vein thrombosis
• Social History: Married, lives with wife, supportive family

Physical examination

• systolic murmur, abdomen obese but benign, minimal peripheral edema, dry skin, onychomycosis, non focal neurologic exam

Dosage

• Medications:
  • atenolol, carbamazepine, citalopram, fosinopril, HCTZ, nifedipine, terazosin

Laboratory

• CBC, electrolytes, serum Ca+2, serum vitamin B12, serum folate, serum ALT, serum creatinine, serum TSH, all normal
• RPR negative, HgbA1c 5.5%,
• serum HDL cholesterol 38 mg/dl, serum LDL cholesterol 205 mg/dl

Radiology

• knee X-ray unremarkable
• US left leg is unremarkable
• MRI of brain is pending

More general terms

• case presentation

Additional terms

• altered state of consciousness