Case #2: A Little Jumpy
Author: Jami Hickey, MD
Peer Reviewer: Mark Mycyk, MD
A 34 year old man is brought to the emergency department by his wife who states that he has had confusion and difficulty walking for the past two hours. Per his wife, he was acting normally last night before going to bed, but after breakfast this morning was “just not himself”. His only past medical history is depression, but he has recently been complaining of nasal congestion and a dry cough.
Vitals: T: 102.2, HR: 112, BP: 120/80, RR: 20, O2 Sat: 98% on RA
On physical examination the patient is able to tell you his name and knows he is in the hospital but is unclear on the date and seems very sleepy. He is mildly diaphoretic. The remainder of his exam is significant only for increased tone and hyperreflexia of the bilateral lower extremities.
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