Aspirin (ASA) was given and the patient was admitted for elevated troponin. However, her troponin was elevated to 0.79 ng/mL (normal ≤0.04 ng/mL). Biological parameters and diagnostic tests ruled out metabolic disorders (i.e., hypoglycemia, hypocalcemia), infection, fluid/electrolyte derangement as underlying etiology of her acute presentation and the lack of disturbance of consciousness and altered cognition excluded delirium. A brain computed tomography without contrast showed diffuse cerebral atrophy, otherwise no acute findings or prior infarcts. Physical examination revealed no focal neurological or epileptic signs or symptoms. Otherwise alert and oriented to person, place, and time with no aphasia or cognitive deficits. On examination, she continued perseveration of the same questions/statements (What happened? Where did I come from? Who brought me here?). Upon arrival to the emergency department, she was found to be hypertensive to 171/79 mmHg. She also denied any dizziness, anxiety, nausea, paresthesia, chest pain, shortness of breath, abdominal pain, dysuria, or any other symptoms. In addition, she had been having suboccipital pressure sensation and notably had migraines in the past, but denied any migraines or headaches for several years now.
She also reported increased stress recently due to her computer classes at a local public school. She previously spent all her time caring for him because of his advanced Alzheimer’s. She recalled waking up in her usual state of health and going to the nearby senior center, as she frequently does for daytime activity since the passing of her husband this past year. At baseline, she is fully conversant and entirely independent in activities of daily living. No other neurological symptoms or signs were reported. She was noted as having a “moment of memory lapse”, then appeared disoriented with repetitive queries. Emergency medical service was called once the staff at the facility noticed she was suddenly confused. A 69-year-old female with past medical history of hypertension being treated with metoprolol, presented with an acute episode of altered mental status.
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