A Case of 60-Year-Old Woman with Altered Mental Status and W
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A 60-year-old woman presented with altered mental status during the pandemic of (Covid-19), the disease caused by (SARS-CoV-2). The patient had been in her usual state of health until 1 week before admission, when cough and headache developed. One day before admission, vomiting and diarrhea developed. The husband reported that the patient awoke screaming at 1:00 a.m. on the day of admission, and emergency medical services (EMS) were called. When EMS personnel arrived, the patient was reportedly lethargic and unable to answer questions. The blood glucose level, obtained by fingerstick testing, was 60 mg/deciliter. IV dextrose was administered. A repeat fingerstick glucose measurement was 127 mg per deciliter and the lethargy abated.

In the emergency department, the patient reported weakness on the left side of her body and persistent headache. She reported that when she had awoken at 1:00 a.m., she was unable to move or speak, was afraid she was going to die, and began screaming for help. She did not speak English and was marginally housed, sleeping in the living room of a friend’s apartment with her husband. Several people living in the apartment had had cough and fever.

The patient had a history of diabetes mellitus, hypertension, and schizophrenia. Medications included aspirin, glipizide, hydrochlorothiazide, lisinopril, and risperidone. She had no known drug allergies.

On examination, the temperature was 37.4°C, the blood pressure 114/62 mm Hg, the heart rate 94 beats per minute, the respiratory rate 18 breaths per minute, and the oxygen saturation 94% while the patient was breathing ambient air; the body-mass index was 30.5. The patient was alert and interactive. She was oriented to person and place but not to time. She had difficulty manipulating small objects placed in the left hand. The left arm showed pronator drift and orbiting.

In conclusion, this patient’s brief psychosis was probably related to direct and indirect effects of SARS-CoV-2 infection, including the socioeconomic effect of Covid-19 in combination with underlying schizophrenia, and to the new infarct in the right hemisphere. The small-vessel stroke resulting from lipohyalinosis was probably triggered by Covid-19, although direct viral mechanisms cannot be ruled out.

source: https://www.nejm.org/doi/full/10.1056/NEJMcpc2004976
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