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Case Reports
. 2014 Aug 5:2014:bcr2013203181.
doi: 10.1136/bcr-2013-203181.

An unusual cause of altered mental status: the importance of monitoring a patient's blood pressure

Jacob Mathew Jr  1 , Matthew Koo  2 , Irina R Crook  1 , Jay Jahanmir  1
Affiliations
Case Reports

An unusual cause of altered mental status: the importance of monitoring a patient's blood pressure

Jacob Mathew Jr et al. BMJ Case Rep. .

Abstract

A 73-year-old man presented to the emergency room for acute onset altered mental status. The initial work-up yielded no definitive cause. An MRI demonstrated lesions in the bilateral posterior occipital lobes (not noted on an earlier MRI obtained from an outside institution) that were suggestive of posterior reversible encephalopathy syndrome (PRES). He had a history of Parkinson's disease complicated by autonomic instability (wide blood pressure fluctuations) that was medically controlled in the outpatient setting. During the early course of his hospitalisation, he again displayed wide blood pressure fluctuations. After his blood pressure stabilised, his mental status eventually improved to baseline. A repeat MRI obtained demonstrated near-complete resolution of the previously noted lesions and confirmed the diagnosis of PRES.

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Figures

Figure 1
Figure 1
MRI without gadolinium revealing hypodensities present in cortical and subcortical occipital lobes bilaterally in the parieto-occipital regions.
Figure 2
Figure 2
MRI without gadolinium showing resolution of hypodensities originally present in the parieto-occipital regions.
See this image and copyright information in PMC

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