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{
    "pk": 29335,
    "title": "Challenges in Diagnosis and Management of Altered Mental Status in the Setting of Urosepsis and Hydrocephalus Secondary to an Occlusive Cyst of the Fourth Ventricle: A Case Report",
    "subtitle": null,
    "abstract": "<p>Introduction: Hydrocephalus presents a diagnostic and therapeutic challenge due to its diverse clinical manifestations and underlying causes. Symptoms can vary from feelings of unsteadiness to focal symptoms such as weakness, difficulty ambulating, or urinary incontinence. Due to the wide variety of symptoms, hydrocephalus can present a difficult diagnosis for any physician and may require different interventions depending on the underlying cause.</p>\n<p>Case Report: This case report highlights a 69-year-old female with altered mental status, initially diagnosed with communicating hydrocephalus and sepsis. The patient’s symptoms, including confusion, urinary dysfunction, and gait ataxia, initially masked the hydrocephalus, emphasizing the importance of considering this condition in patients with prolonged progression of neurological deficits. Brain imaging, including magnetic resonance imaging (MRI) and computed tomography (CT), facilitated the diagnosis, suggesting hydrocephalus with downward tonsillar herniation. The acute management involved empirical antibiotic therapy for associated sepsis, followed by the placement of an external ventricular drain for cerebrospinal fluid diversion and sampling, including cytology and cell counts, given the concern for tonsillar herniation with a lumbar puncture. Cine MRI and CT cisternogram demonstrated a cyst filling the volume of the fourth ventricle. Subsequent surgical fenestration of the cyst using a suboccipital craniotomy for cyst resection alleviated symptoms and stabilized ventricular size.</p>\n<p>Conclusion: Hydrocephalus can present with unique and varying symptoms, and it can have a variety of underlying causes. This case underscores the necessity for individualized treatment approaches tailored to the underlying etiology of hydrocephalus, including temporizing measures and more aggressive approaches once infection has improved.</p>",
    "language": "eng",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "hydrocephalus"
        },
        {
            "word": "Trauma"
        },
        {
            "word": "case report"
        },
        {
            "word": "altered mental status"
        },
        {
            "word": "external ventricular drain"
        }
    ],
    "section": "Case Reports",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/7nf666d7",
    "frozenauthors": [
        {
            "first_name": "Matthew",
            "middle_name": "",
            "last_name": "Van Ligten",
            "name_suffix": "",
            "institution": "Mayo Clinic, Arizona Department of Emergency Medicine, Phoenix, Arizona",
            "department": ""
        },
        {
            "first_name": "Miles",
            "middle_name": "",
            "last_name": "Hudson",
            "name_suffix": "",
            "institution": "Mayo Clinic, Arizona Department of Neurosurgery, Phoenix, Arizona",
            "department": ""
        },
        {
            "first_name": "Jonathon",
            "middle_name": "",
            "last_name": "Parker",
            "name_suffix": "",
            "institution": "Mayo Clinic, Arizona Department of Emergency Medicine, Phoenix, Arizona",
            "department": ""
        },
        {
            "first_name": "Wayne",
            "middle_name": "",
            "last_name": "Martini",
            "name_suffix": "",
            "institution": "Mayo Clinic, Arizona Department of Neurosurgery, Phoenix, Arizona",
            "department": ""
        }
    ],
    "date_submitted": "2024-07-15T16:15:55.871000-07:00",
    "date_accepted": "2024-09-11T11:40:29.804000-07:00",
    "date_published": "2025-01-01T19:20:00-08:00",
    "render_galley": null,
    "galleys": [
        {
            "label": "PDF",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/uciem_cpcem/article/29335/galley/31525/download/"
        }
    ]
}