Altered Mental Status & Hypotension & Spasticity - Hyperreflexia: Causes & Reasons

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Patient File

Sex unknown, Age unknown

Reported Symptoms

Altered Mental Status, Hypotension, Spasticity - Hyperreflexia,

Negated

None

Unsure

None

Possible Causes

Hyponatremia

They are primarily central nervous system (CNS) manifestations, such as irritability, restlessness, lethargy, muscular twitching, spasticity and hyperreflexia, all of which [aafp.org]

After several weeks of suffering from gastroenteritis with vomiting, she presented with disturbance of consciousness, hypotension, dehydration, and severe hyponatremia (108 [ncbi.nlm.nih.gov]

Her serum [Na] and altered mental status corrected slowly over the next 48 hours with furosemide, hypertonic saline, and fluid restriction. [ncbi.nlm.nih.gov]

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Hypernatremia

Muscle twitching, tremor, spasticity, hyperreflexia, and lethargy may also be seen. Coma, seizures, and muscle weakness are later signs. [aneskey.com]

A shunt tap revealed intracranial hypotension with good proximal flow. [ncbi.nlm.nih.gov]

A 61-year-old male presents in middle of July with altered mental status. [emdocs.net]

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Phenothiazine Poisoning

[…] occur with more frequency in patients in a toxic condition and in dehydrated and febrile patients.3 There is little mention in the literature of reactions which produce spasticity [jamanetwork.com]

[…] other arrhythmia, hypotension and even shock. [healthfrom.com]

Thiamine should be given routinely to all alcoholics or malnourished patients with altered mental status. [mcgill.ca]

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Encephalopathy

Hepatic myelopathy [54] is characterized by a progressive spastic paraparesis accompanied by hyperreflexia and extensor plantar responses. [hindawi.com]

Cerebrospinal fluid hypotension is also a reported plausible pathogenic mechanism. [ncbi.nlm.nih.gov]

mental status, tonic-clonic seizures, and hypertension. [ncbi.nlm.nih.gov]

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Central Pontine Myelinolysis

horizontal gaze paralysis), impaired speech or swallowing, and signs of spastic quadriplegia such as limb weakness, increased tonicity of the limb muscles, and hyperreflexia [symptoma.com]

Repeated vomiting due to an upper respiratory infection caused disturbance of consciousness and hypotension. [ncbi.nlm.nih.gov]

mental status. [ncbi.nlm.nih.gov]

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Primary Progressive Multiple Sclerosis

Affected individuals may have tremors, muscle stiffness (spasticity), exaggerated reflexes (hyperreflexia), weakness or partial paralysis of the muscles of the limbs, difficulty [icdlist.com]

[…] reactions, which can include pruritus, rash, urticaria, erythema, bronchospasm, throat irritation, oropharyngeal pain, dyspnea, pharyngeal or laryngeal edema, flushing, hypotension [ocrevus.com]

Pyramidal functional system impairment (ie, limb weakness, spasticity, or hyperreflexia) was seen in the following patterns, typically with sparing of the facial musculature [jamanetwork.com]

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Hepatic Encephalopathy

Hepatic myelopathy [54] is characterized by a progressive spastic paraparesis accompanied by hyperreflexia and extensor plantar responses. [hindawi.com]

[…] protein Portosystemic shunt (iatrogenic and spontaneous) Impaired toxin clearance Dehydration due to excessive fluid restriction, excessive diuresis or paracentesis, diarrhea Hypotension [cancertherapyadvisor.com]

We report a case of a 52-year-old male with liver cirrhosis presenting an altered mental status. [ncbi.nlm.nih.gov]

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AIDS-Associated Meningoencephalitis

On examination, one finds relatively symmetric leg weakness, sensory loss, particularly in vibration and position sense, spasticity and hyperreflexia of both legs, and Babinski [hivinsite.ucsf.edu]

Shock: signs of shock include tachycardia and/or hypotension, respiratory distress, altered mental state and poor urine output. [patient.info]

Altered mental status is rare and if present should increase suspicion for acute purulent meningitis or encephalitis. [infectiousdiseaseadvisor.com]

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Spinal Cord Transection

It presents with spastic paresis, hyperreflexia, and continued sensory loss. [amboss.com]

Abstract Orthostatic hypotension commonly occurs in persons with spinal cord injury (SCI), limiting rehabilitation and independence. [ncbi.nlm.nih.gov]

Postoperatively, the patient developed intermittent episodes of hypertension, bradycardia, headaches, altered mental status, severe perspiration, and red flushing of the upper [ncbi.nlm.nih.gov]

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Susac Syndrome

Headaches persisted in 2 patients, sphincter dysfunction in 2 patients, and prominent upper motor neuron signs (spastic paraparesis, hyperreflexia) in one patient. [jns-journal.com]

AION rarely occurs in the setting of hypotension or blood loss alone, and the combination of the two is probably important in the pathogenesis. [emedicine.medscape.com]

Physical examination normalized in all but 2 patients in whom hyperreflexia and Babinski sign were persistent. [cdn.journals.lww.com]

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Multiple Sclerosis

Affected individuals may have tremors, muscle stiffness (spasticity), exaggerated reflexes (hyperreflexia), weakness or partial paralysis of the muscles of the limbs, difficulty [ghr.nlm.nih.gov]

Allergic reactions are often associated with cutaneous symptoms, including urticaria, angioedema, and flushing, and may also include respiratory symptoms and hypotension,12 [dx.doi.org]

CASE REPORT We report on a case of a 45-year-old female multiple sclerosis (MS) patient presenting with acute onset short-term memory loss, altered mental status, inflammatory [ncbi.nlm.nih.gov]

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Lead Encephalopathy

On clinical examination, the patient showed memory loss, mild disorientation, and weakness in the limbs with bilateral hypertonia and hyperreflexia, plantar upgoing, and spastic [ajnr.org]

Hypotension Transaminase elevations ECG changes Nephrotoxicity secondary to dissociation of EDTA-metal complexes in acidic urine – reduced by ensuring adequate hydration and [lifeinthefastlane.com]

A 66-year-old woman presented to a hospital with headache, irritability, and altered mental status. [ncbi.nlm.nih.gov]

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Spinal Shock

PHASE 4- SPASTICITY/HYPERREFLEXIA (1-12 MONTHS) CLINICAL DESCRIPTION-  DPR disappear in majority cases.  Cutaneous reflexes, DTRs and Babinski sign become hyperactive and [slideshare.net]

Despite this, hypotension persisted and the heart rate remained between 60 and 70 BPM. [wjgnet.com]

mental status, suspected extremity fracture or distracting injury, or spine pain/tenderness. [jems.com]

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Spinal Trauma

It presents with spastic paresis, hyperreflexia, and continued sensory loss. [amboss.com]

What is the most likely cause of hypotension in a major trauma patient with a possible spinal cord injury? [lifeinthefastlane.com]

mental status. [east.org]

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Creutzfeldt Jakob Disease

Clinical features of sCJD include myoclonic jerks, memory deficits, cerebellar signs (ataxia, nystagmus, tremors), pyramidal/corticospinal tract dysfunctions (spasticity, [doi.org]

[…] includes sleep disturbance and distal pain and may include abnormalities of the autonomic nervous system: palpitations, temperature dysregulation, hypertension or postural hypotension [doi.org]

— Acute cerebellitis is a clinically defined condition most commonly characterized by acute cerebellar ataxia, associated with nausea, headache, and altered mental status [doi.org]

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Central Nervous System Disorder

tremor, spasticity, ataxia, contracture and paralysis sensory: hypoesthesia, numbness, paraesthesia, burning and shooting pain autonomic: urinary and defecatory problems [quizlet.com]

[…] disorders of nervous system, not elsewhere classified G97.0 Cerebrospinal fluid leak from spinal puncture G97.1 Other reaction to spinal and lumbar puncture G97.2 Intracranial hypotension [icd10data.com]

Myocardial infarction, postural hypotension, and stenosis or narrowing of the carotid or vertebral arteries greater than 60% are common causes of cerebral ischemia. [encyclopedia2.thefreedictionary.com]

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Neuromuscular Junction Disorder

Upper motor neuronal dysfunction lead to spasticity and hyperreflexia while lower motor neuronal lesions lead to paralysis with muscle fasciculations. [lecturio.com]

Autonomic dysfunction (blurred vision, diplopia, bradycardia, and hypotension) followed by descending flaccid paralysis occur Wound botulism Results from contamination of [academic.oup.com]

Offers thorough updates and the following NEW topics: Descriptions of altered mental status, including the minimally responsive state and minimal cognitive impairment Neurotoxins [books.google.de]

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Coma

[…] with hyperreflexia, quadrispasticity, pupillary fixation to light, decorticate rigidity, decerebrate rigidity. [headinjury.com]

We report 3 cases of spontaneous intracranial hypotension (SIH) associated with consciousness disorder and coma. [ncbi.nlm.nih.gov]

History would reveal the etiology of the altered mental status, but the altered mental status obscures information of recent events. [ncbi.nlm.nih.gov]

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Binswanger Disease

Low back pain Progressive encephalopathy Pseudobulbar signs Rigidity Spasticity Urinary incontinence Last updated: 1/1/2017 Source: GARD (NIH) 1 • • • Back to: « Cerebral [familydiagnosis.com]

This pallor can only be due to cerebral edema, most likely of hypoxic-ischemic, hypotensive, or acidotic origin. [ncbi.nlm.nih.gov]

Related articles: Ischemic stroke, Approach to cognitive impariment, Approach to acute confusion “altered mental status” , [learningneurology.com]

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Autonomic Dysreflexia

When the stage of spinal shock passes, the typical UMN picture within hyperreflexia and spastic paralysis below the level of the injury supervenes. [casemed.case.edu]

Treatment of orthostatic hypotension with fludrocortisone acetate relieved these symptoms. [ncbi.nlm.nih.gov]

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Meningeal Disorder

hyperreflexia/extensor plantar response (upgoing toe) vacuolar myelopathy vacuolation of myelin in the posterior and lateral columns of the primarily thoracic spinal cord [strokecenter.org]

mental status (confusion) Newborns and babies may not have or it may be difficult to notice the classic symptoms listed above. [cdc.gov]

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Proximal Myopathy with Extrapyramidal Signs

The essential clinical findings are slowly progressive and often include severe spasticity, hyperreflexia, and weakness in a pyramidal distribution, noticeably in both lower [emedicine.medscape.com]

Dizziness or significant hypotension after treatment with the injection is a rare occurrence. [mentalhealth.com]

Thus, weakness accompanied by spasticity, hyperreflexia, and Babinski responses (up-going toes) suggests upper motor neuron dysfunction. [casemed.case.edu]

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Pyelonephritis

Symptoms and Signs Cord compression commonly causes gradual spastic paresis, paresthesias, or both in the hands and feet and may cause hyperreflexia. [msdmanuals.com]

Severe complicated cases can lead to septicaemia, hypotension and shock if left untreated. [symptoma.com]

System(s) affected: renal; urologic Synonym: acute upper urinary tract infection (UTI) Geriatric Considerations May present as altered mental status; absence of fever is common [unboundmedicine.com]

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X-linked Parkinsonism-Spasticity Syndrome

Clinical manifestations include progressive MUSCLE SPASTICITY; hyperreflexia; MUSCLE RIGIDITY; DYSTONIA; DYSARTHRIA; and intellectual deterioration which progresses to severe [medvik.cz]

Abnormal autonomic nervous system physiology Hypometric saccades Hypotension Optic atrophy Delayed speech and language development Behavioral abnormality Substantia nigra [mendelian.co]

mental status, and autonomic dysfunction; may occur with either severe blockade (high doses of neuroleptics) or sudden depletion (withdrawal of neuroleptics) of dopamine [strokecenter.org]

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Spastic Ataxia with Congenital Miosis

Clinical features included severe mental retardation, dysarthria, ataxia, athetoid movements, muscle hypoplasia, and spastic paraplegia with hyperreflexia, clonus, an... [findzebra.com]

S/S of orthostatic hypotension and treatment in the elderly* Definition The most common symptom of orthostatic hypotension is feeling lightheaded or dizzy when you stand up [flashcardmachine.com]

Other signs of meningitis are nuchal rigidity, limited flexion of the legs, altered mental status, and fever. [headnecksurgery.wordpress.com]

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Cerebellar Stroke

(spasticity, hyperreflexia, and pathological reflexes) Datar S, Rabinstein AA. Cerebellar infarction. Neurologic clinics. 2014 Nov 1;32(4):979-91. 17. [slideshare.net]

In previously reported stroke cases theorizing pathogenesis, vasospasm and hypotension have been invoked. [pediatrics.aappublications.org]

Manifestations may be nonspecific and include the following: Headache Altered mental status Ataxia Nausea Vomiting Weakness Gait disturbance CNS neoplasms also may manifest [emedicine.medscape.com]

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Spinal Cord Injury

Spasticity is characterized as hyperreflexia and hypertonicity as a result of damage to the supraspinal tracts in the aftermath of SCI. [ncbi.nlm.nih.gov]

The patient also had orthostatic hypotension and post-prandial hypotension associated with an increased insulin level. [ncbi.nlm.nih.gov]

Paramedics bring a 26-year-old man to the ED with acute-onset altered mental status. He has a history of back pain. An open, unlabeled pillbox was found. [emedicine.medscape.com]

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Diffuse Serous Labyrinthitis

On examination, he is found to have normal reflexes and strength in his arms and hyperreflexia in his legs with upgoing toes, and his gait is spastic. [classes.kumc.edu]

Two new chapters on Hypotension and Photophobia. [books.google.de]

Hypoglycemia – severe, reversible cause of altered mental status in children. [ahcmedia.com]

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Spinal Cord Tumor

Physical Findings on physical examination correspond to the location of the tumor, degree of cord impingement, and duration, and may include the following: Spasticity; hyperreflexia [emedicine.medscape.com]

Effect of intraoperative hypotension and hypothermia on IOM In our study, six false positive MEP cases were with intraoperative hypotension and/ or hypothermia. [omicsonline.org]

Patients with cerebral Toxoplasmosis may present with altered mental status (62%), fever (41%), or headaches (59%) associated with focal neurologic deficits [ 1 ]. [neurosurgery.imedpub.com]

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Achalasia - Microcephaly Syndrome

Talipes equinovarus Cerebellar atrophy Babinski sign Ptosis Coarse facial features Neonatal hypotonia Wide mouth Spastic paraplegia Thin upper lip vermilion Muscular hypotonia [mendelian.co]

He was found to have hyperpigmentation at pressure points, postural hypotension and other features of autonomic dysfunction. [annalsofian.org]

Mental Status AMS Academic Management Services AMS Aggregate Measure of Support AMS Australasian Menopause Society (est. 1988) AMS Access Method Services AMS Advanced Medical [acronyms.thefreedictionary.com]

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