A 72-year-old veteran with a past medical history of nonalcoholic steatohepatitis
with compensated cirrhosis, history of grade 1 esophageal varices managed medically,
diabetes mellitus, and coronary artery disease, presented to the emergency department
(ED) with increasing confusion. He had been seen by his primary care provider 1 week
prior to the onset of symptoms without any complaints and had been working on his
roof to clean out the gutters 4 days before coming to the ED. According to his family,
the patient began to perseverate on his computer and became progressively less interactive
with his family over the 3 days prior to coming into the ED. His speech became slurred
and ultimately unintelligible, and he appeared to see things that were not present
to others. His family also noted that he seemed to have new tremors in both of his
arms over the 2 days prior to admission. He was brought to the ED for further management.
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Article info
Publication history
Published online: February 19, 2020
Thomas J. Marrie, MD, Section EditorFootnotes
Funding: None.
Conflicts of Interest: None.
Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
Copyright
Published by Elsevier Inc.