A Man in His 40s With Headache, Lethargy, and Altered Mental Status

JAMA Neurol. 2015 Sep;72(9):1061-5. doi: 10.1001/jamaneurol.2015.1375.

Abstract

A man in his 40s presented with 1 month of worsening confusion, fatigue, and headache. Results from laboratory analyses were notable for a complete white blood cell count of 17 000/μL (31% blast cells), a platelet count of 76 000/μL, and a hemoglobin level of 16.6 g/dL. Imaging studies revealed a large mixed-attenuation subdural collection in the right frontal region with prominent mass effect. The patient underwent an emergency neurosurgical procedure. The differential diagnosis, pathologic findings, and diagnosis are discussed.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antineoplastic Agents, Hormonal / therapeutic use
  • Craniotomy / methods
  • DNA Nucleotidylexotransferase / metabolism
  • Dexamethasone / therapeutic use
  • Headache / complications
  • Headache / etiology*
  • Headache / therapy
  • Humans
  • Lethargy / complications
  • Lethargy / etiology*
  • Lethargy / therapy
  • Leukemia / complications*
  • Leukemia / diagnosis*
  • Leukemia / therapy
  • Leukocytes, Mononuclear / pathology
  • Levetiracetam
  • Magnetic Resonance Imaging
  • Male
  • Mental Disorders / complications
  • Mental Disorders / etiology*
  • Mental Disorders / therapy
  • Nootropic Agents / therapeutic use
  • Piracetam / analogs & derivatives
  • Piracetam / therapeutic use
  • Tomography, X-Ray Computed

Substances

  • Antineoplastic Agents, Hormonal
  • Nootropic Agents
  • Levetiracetam
  • Dexamethasone
  • DNA Nucleotidylexotransferase
  • Piracetam