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Acute mental status changes, TIA, no facial drooping. History of diabetes. Treatment?

My 72 y. O. Mom is having acute mental status changes. MRI showed chronic global ischemia . Md says she has a TIA but symptoms persisting 12 hours. Weakness to either extremity; no facial drooping. Disoriented X3. + amnesia .passed out and had MVA.h/o diabetes, NASH, recent CHF. Just list 20lb in 2 weeks after diuretic dose increased. What are differential diagnoses?
Asked On : Tue, 4 Sep 2012
Answers:  1 Views:  68
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Diabetologist 's  Response
1.Elderly diabetics are prone to develop lacunar infarcts(blockade of very fine blood vessels traversing through deep seated brain tissue which are sometimes difficult to be detected even with the most sophisticated imaging modalities like MRI).

2.Disturbance of electrolytes like Na+ and K+ is another possibility as she had been taking high doses of diuretics.

3.Very high or very low blood sugar levels may lead to mental status changes.

4.Acute renal insufficiency(kidney dysfunction) due to high blood sugar levels or liver dysfunction may also cause altered sensorium.
5.Chronic uncontrolled high blood pressure may also lead to changes in mentation.
Regards and best wishes
Answered: Tue, 4 Sep 2012
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