MD, Professor of Radiology, University Distinguished William H. and Patricia W. Child Presidential Endowed Chair in Radiology, Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT USA
Patients who present with “altered mental status,” confusion or delirium, or simply “not acting right” frequently are referred for brain imaging. This two-part lecture focuses on those hyperacute and acute entities in which a correct diagnosis within minutes or a few hours may significantly affect patient outcome. We begin with an overview of toxic-metabolic CNS disorders and their radiologic-pathologic correlation. Using this as a foundation, we then approach imaging in the patient with acutely altered mental status. We consider what to do with unexpected findings in disorders such as Wernicke encephalopathy. Acute hypertensive encephalopathy with “atypical” findings, liver disease with acute hyperammonemia, hypoglycemia, nonconvulsive status epilepticus and “weird strokes” will be discussed. We will also consider less well-recognized non-metabolic causes of acute mental decompensation in settings such as critical illness-associated encephalopathy and post-operative CNS disorders.