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Case Reports
. 2021 Feb;159(2):e75-e79.
doi: 10.1016/j.chest.2020.08.2098.

Altered Mental Status After Esophagogastroduodenoscopy

Joshua D Lee  1 , Daniel F Gallego  2 , James Malleis  2 , Kelly D Smith  2 , Andrew M Luks  3 , Desiree A Marshall  2
Affiliations
Case Reports

Altered Mental Status After Esophagogastroduodenoscopy

Joshua D Lee et al. Chest. 2021 Feb.

Abstract

A 79-year-old man with medical history of atrial fibrillation and esophageal cancer status post trans-hiatal esophageal resection and chemotherapy presented with altered mental status after outpatient esophagogastroduodenoscopy (EGD). One month before presentation, the patient was seen at another hospital with severe anemia and melena requiring transfusion of multiple units of RBCs. No endoscopy was performed during that admission, but his anticoagulation was held. After follow-up with his oncologist, he was referred for outpatient endoscopy. His esophagogastroduodenoscopy demonstrated an intact esophagogastric anastomosis as well as two gastric ulcers with no stigmata of recent bleeding. The patient was discharged to home in good condition with normal mental status. Several hours later, he developed a deteriorating level of consciousness, prompting presentation to the hospital.

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Figures

Figure 1
Figure 1
MRI brain (DWI sequence, B1000) showing extensive acute/subacute supratentorial and infratentorial cerebral infarcts in the (A) bilateral frontal and parietal lobes, (B) thalami and occipital lobes, and (C) cerebellum.
Figure 2
Figure 2
Transthoracic echocardiography demonstrating an area of hyperintensive signal (red arrow) in the left atrium (LA).
Figure 3
Figure 3
A, Epicardial surface of the left atrium near the pulmonary vein after formalin fixation, demonstrating dark-brown, granular discoloration. B, Microscopic examination of this area demonstrating mixed inflammation and necrosis with devitalized muscle and collagenous tissues.
Figure 4
Figure 4
Microscopic images of systemic emboli in blood vessels throughout the body. A, Foreign body material with associated multinucleated/giant cell reaction. B, Intravascular foreign particles are appreciated under polarized light. C, Embolism consisting of devitalized skeletal muscle.
Figure 5
Figure 5
Pathologic examination of the brain. A, Gross section detailing multiple areas of extensive softening with punctate hemorrhage and discoloration involving both hemispheres, including the frontal, occipital, and parietal poles. B, Microscopic section of abnormal brain parenchyma demonstrating intravascular embolic foreign material and giant cell reaction.
See this image and copyright information in PMC

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