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25 Possible Causes for Altered Mental Status, Papilledema, Prominent Sulci

  • Hypertensive Encephalopathy

    There was complete resolution of cerebral edema in all patients and mild interval prominence of the cerebral sulci, which can indicate cerebral volume loss, in three out of[] Clinical manifestations include headache; nausea; vomiting; seizures; altered mental status (in some cases progressing to coma); papilledema; and retinal hemorrhage ICD-9-[] His altered mental status, however, resolved with control of blood pressure.[]

  • Meningoencephalitis

    MRI of the brain showed some effacement of cortical sulci, rendering the vessels prominent, with increased T2-weighted signal diffusely scattered throughout both hemispheres[] Fundoscopy revealed bilateral gross papilledema with positive neck stiffness.[] An extensive laboratory workup for the etiology of his altered mental status was unremarkable, except for a mildly elevated white blood cell count in the cerebrospinal fluid[]

  • Brain Stem Herniation

    The fluid space between the cortex and the calvarium appears to be increased and the sulci/gyri may appear prominent. View prominent sulci/gyri.[] Papilledema Papilledema. The edematous optic papillae protrude forward into the vitreous chamber. Normal white matter Edematous white matter Edematous white matter.[] ., papilledema ) can detect ICP elevation, but not necessarily rule it out. Therefore, ICP monitoring and quantification is vital in at-risk patients.[]

  • West Nile Encephalitis

    Arrows indicate subtle enhancement in the sulci. B and C, FLAIR images show increased signal intensity in the sulci, more prominent on the left than on the right.[] We report the case of a 46-year-old woman who presented with fever, altered mental status, and maculopapular rash, who was diagnosed with locally acquired WNV encephalitis[] Patients usually have a fever, headache, and altered mental status.[]

  • Obstructive Hydrocephalus

    Pre-contrast axial CT Sulci and gyri are very prominent due to cortical atrophy, unlike in obstructive hydrocephalus where there is effacement of sulci and gyri.[] A 40-year-old African American man presented with papilledema, diplopia, and headache.[] All had mean arterial pressures above 130 mmHg and presented primarily with altered mental status. While half required ventriculostomy, only one required shunting.[]

  • Leptomeningeal Metastasis

    The lesions were more prominent in the cerebellar sulci compared with in the cerebral sulci.[] These may include headaches, changes in mental status, nausea and vomiting, difficulty with balance, seizures and papilledema.[] Patients may present with an altered mental status. Additionally, focal or generalized seizures, as well as meningism, may be reported.[]

  • AIDS-associated Meningoencephalitis

    MRI of the brain showed some effacement of cortical sulci, rendering the vessels prominent, with increased T2-weighted signal diffusely scattered throughout both hemispheres[] Keane, 7 in a series of 50 patients with AIDS, observed visual abnormalities in 18 patients (papilledema in eight, and neuropathy in four).[] Altered mental status is rare and if present should increase suspicion for acute purulent meningitis or encephalitis.[]

  • Postictal State

    Ventricles, sulci and cisterns were mildly prominent for age and there was mild cerebral cortical volume loss.[] Evaluate patients with seizures for signs of possible causes (eg, fever, stiff neck, focal neurologic deficits, neuromuscular irritability and hyperreflexia, papilledema),[] If a patient remains confused for longer than 20 minutes after a seizure, consider another cause of altered mental status [4].[]

  • Subacute Sclerosing Panencephalitis

    They can range from hyperintensities in the parietal and occipital region, brain stem lesions, and marked atrophy, causing prominence of sulci.[] On admission, five patients (group 1) presenting with pseudotumor cerebri exhibited bilateral papilledema, and in each of them cranial magnetic resonance imaging revealed[] mental status.[]

  • Communicating Hydrocephalus

    CT and MRI reveal bilateral extracerebral fluid collections, prominent sulci, normal ventricles, and no evidence of compression of the brain.[] A patient with communicating hydrocephalus had recurrent papilledema during episodes of thyrotoxicosis.[] He subsequently had intermittent headaches and altered mental status that resolved without intervention.[]

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