Mystery Patient, Mystery symptoms

[Jess_tonel]

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Hey can you Nuero guys / gals give view on this case....

Patient arrives in ER (A&E) claiming to have been spiked at a party frequented by Psychiatry students...........

After 3 hours: Patient feeling heavy eyes,, occasional problem retrieving correct word for verbal conversation.

Day 3 : Above symptoms worsen , demotivated, patchy long term memory, increased appetite, dry mouth, water consumption doubled/trebled, constipation. slightly off balance when first standing. sleep ok.

Day 7: Above symptoms persist. sleeping well

Day 8: Awake in night . heavy headedness lifted, sedative feeling waining , replaced with anxiety, confusion, suicidal urges, sharp stabbing headache in 'front half of Brain' from ear to ear. appetite still good.,

Day: 15: Headaches diminishing slowly, but still feeling persistent pressure just above eyes and in the temple, hands and feet feel weak and shakey, slurred speech, drooling from corners of mouth when eating, drinking, Patient reports lack of understanding with complex ideas. along with poor preplanning, feels low on emotion water consumption back to normal.

Day 22: Headaches lingering slightly, feeling of pressure above eyes, weakness of hands and feet lifted, Patient reports slight drooling from corners of mouth still present but not noticeable .occasional bouts of confusion. At this point patient not very conversational. claims to be lacking usual emotional responses, patient reports a poor understanding of complex ideas, poor short term memory, (previously intelligent with job in IT.)

Could you Nuero guys tell me what you think has happenedNuerologically? can it recover over time? My feeling is a chemically induced trauma to the frontal lobe, Nuero is a gap in my knowledge at present, can anybody help?.

After initial scepticism I now believe the patient's story, what was he under? My guess is Atypical meds with other(s), but what? (Question for Psychiatrists maybe)

Prognosis for patient?

 

[neurodoc]

Sounds a bit "psych" to me, but that's just my first take.

 

[neglect]

Volitional intoxication, now lying, followed by psychiatric. Reassure. And spell neuro as neuro.

 

[neurologist]

Chronic CNS Lyme disease.

 

[soulofmpatel]

Most forms of acute intoxication do not last > 3 weeks, though there are rare exceptions. The people above are skeptical of the story because most things that would be used to spike a drink at a party [rohypnol, LSD, etc] are very short acting and cause a more dramatic acute intoxication syndrome that is clearly temporally related to the inciting event. Exceptions could be something like huffing paint or "chasing the dragon" on aluminum which can cause delayed neurotoxicity (these things can't be slipped into a drink).

the symptoms you're describing are extremely vague. "dry mouth...increased appetite...patchy long term memory...doubling of water intake...constipation...insomnia...emotional changes" - these are nonspecific. You need to test the memory explicitly. Make the patient walk, tandem, etc-is there truly a balance problem or is it elaborated. Do some basic labs. Not all things can be explained medically, but the idea that someone spiked his drink with some slow-acting long term toxin is completely absurd, and the patient should be reassured.

Obviously, since the diagnosis is unknown, it is impossible to comment on prognosis. However, if it is any consolation, most subtle drug induced neuropsychiatric symptoms [i.e. those induced by chantix] improve with time.