Thank you, Katie, for discussing the case of a 64W h/o bipolar disorder on various psychoactive meds, admitted for subacute onset rigidity, increased tone, diaphoresis, whose prolonged workup led to a diagnosis of catatonia.
***Prepare yourself for clinical pearls in table form***
When someone is not responding or participating with your exam, you can adjust your neuro exam to be more in line with a brief Coma Exam:
- CN exam: pupil, corneal, gag, VOR or oculocephalic maneuver, cold calorics (see pic below)
- GCS (motor testing is strongest predictor of outcome)
For this case, one could narrow the framework for AMS+fever to focus on medications…
For serotonin syndrome (SS), think “hot and fast” as discussed today in report and as reflected in the following table diagnostic criteria for SS:
To compare and contrast serotonin syndrome and neuroleptic malignant syndrome further:
From the Ditty:
Anisocytosis: anemia with RBC’s of unequal/abnormal SIZE
Poikilocytosis: anemia with RBC’s of unequal/abnormal SHAPE
HCC screening and mortality reduction…
While the recommendations by the AASLD is to do ultrasound alone q6months (AFP w/ lower sensitivity/specificity) for folks at high risk (see table and article below), the minimal study evidence that exists out of China showed reduction in mortality (37%, Zhang et al 2004) for screening with AFP and ultrasound.
- Q J Med 2003; 96:635–642 doi:10.1093/qjmed/hcg109; http://qjmed.oxfordjournals.org/content/qjmed/96/9/635.full.pdf
- Amit S, Jorge A. M. Screening for Hepatocellular Carcinoma. Gastroenterology & Hepatology. 2008;4(3):201-208