Unusual cause of encephalopathy after brain surgery

For patients who have had a recent neurosurgical procedure, a visit to the emergency department for encephalopathy may automatically prompt a neurosurgical consult. We present a case of a patient with a history of Chiari malformation decompressed 6 months prior who presented with a 2-week history of...

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Published in:BMJ case reports 2017-12, Vol.2017, p.bcr-2017-222253
Main Authors: Mahmooth, Zayan, Malcolm, James G, Wetzel, Jeremy S, Ahmad, Faiz U
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Language:English
Subjects:
Acidosis
Acids
Case reports
Edema
Hemodialysis
Laboratories
Metabolism
Neurosurgery
Patients
Sodium
Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions
Urine
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Malcolm, James G
Wetzel, Jeremy S
Ahmad, Faiz U
description For patients who have had a recent neurosurgical procedure, a visit to the emergency department for encephalopathy may automatically prompt a neurosurgical consult. We present a case of a patient with a history of Chiari malformation decompressed 6 months prior who presented with a 2-week history of slowly progressive altered mental status, headache and imbalance—symptoms consistent with her initial Chiari symptoms, so neurosurgery was consulted. Imaging showed no acute abnormality, but laboratory results revealed metabolic acidosis with high salicylate levels. When reporting medication use, this patient initially left out that she had been taking Goody’s powder (845 mg aspirin) for headaches, and long-term use led to metabolic encephalopathy. Despite a recent history of surgery, it is important to keep the differential diagnosis broad especially when there are signs of metabolic derangement.
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subjects Acidosis
Acids
Case reports
Edema
Hemodialysis
Laboratories
Metabolism
Neurosurgery
Patients
Sodium
Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions
Urine
title Unusual cause of encephalopathy after brain surgery
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