Patient complains of forgetfulness & irritation

Chief Complaint A 59 y/o female presents with some episodes of forgetfulness & irritation for around a month. She said she is not able to concentrate on work also. She is a teacher and teaches kids at home. She is also feeling very emotional for few days. Vitals 115/70 mmhg, Breaths: 20 bpm, HR: 85 bpm, Temperature was 98.2 degree F. Examination Patient seems little confused, rest of the examination is normal. Investigations WBCs: 14.7 × 109/l (normal 5.0–10.0 × 109/l), ESR: 85 mm/h and C-reactive protein of 68.1 mg/l (normal 0.2–9.1 mg/l). Treatment Need your valuable opinion on the case.


Leucocytosis Raised CRP With confusion and forgetfulness history Look for Pyogenic meningitis High ESR look for TBME Septicemia with encephalitis early stage Adv: CT SCAN CSF ADA , CBNAAT TSH

Mood changes... Personality disorders... To see.. Is it psychological Or Organic.. May be frontoparietal.. temporal lobe pathology. Also cortical atrophy. Dyselectrolytaemia Sug. Neurologic check up Psychiatric evaluation Ct brain

Check CSF...For pyogenic meningitis. DD...Viral encephalitis... .......... Meningitis Koch's.. CT scan would be conclusive.

Any significant past medical illness including treatment history ? RaisedESR ,CRP and WBCcount .1 month history sub acute illness Inflammatory in nature. Needs urgent MRI brain with contrast to look for any meningeal enhancement. & CSF study after MRI brain.Further management after investigations

All inflammatory markers are sky high Is there any previous co morbidity Look for Any foci of infection Check for neck rigidity If all negative, go for brain imaging followed by CSF studies

insomnia and memory loss in case of nidranash and memory loss best ayurvedic treatment is brahmi shankhpushpi ashwgandha jatamansi jyotismati bala saunf ka prayog labhkari hai

CT brain start antibiotics

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