Case Study (Mr. Del)
- Mr. Del is a 70-year-old male. He was brought to the Emergency Department by his son because of vomiting, new onset urinary incontinence, confusion, and incoherent speech for the past 2 days.
- The patient was disoriented and could see people climbing trees outside the window. He had difficulty sustaining attention, and his level of consciousness waxed and waned. He had been talking about his deceased wife. Patient was also trying to pull out his intravenous access line.
- Past history included diabetes mellitus, hyperlipidemia, osteoarthritis, and stroke.
Examination Findings
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On examination, the patient was drowsy and falling asleep while practitioners were talking to him. Patient was not cooperative with the physical examination and with a formal mental status examination. Limited examination of the abdomen indicated that it was flat and soft with normal bowel sounds. The patient moves all 4 limbs and plantar is bilateral flexor.
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Laboratory test results revealed elevated BUN and creatinine levels, and the urine analysis was positive for urinary tract infection.
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CT scan of the head showed cortical atrophy plus an old infarct.
Case Development 1:
- Del’s son reluctantly reported that his father has current history of occasional alcohol drinking and using Diazepam to sleep well.
- He admits that he was a heavy alcohol drinker 10 years ago.
- He had bouts of memory impairments and family problems secondary to his heavy drinking.
- He used to have tremors and craving for drinking at early morning.
- After searching patient’s old medical notes, you found that the patient has been admitted to ICU 10 years ago with:
- fever
- sweating
- tremor
- dilated eyes
- disorientation
- confusion
- seeing small animals.
Case Development 2:
- Past history inquiry indicated that he has two years of deteriorating memory.
- He forgot mostly recent things.
- He has difficulty to name some familiar people to him.
- 6 months ago, he lost his ability to drive and to pray appropriately.
- However, his attention was well except of few days’ prior current admission.
- There is positive family history of severe memory problem in his eldest brother.