AMS With Active Cancer

REMEMBER: AMS with brain stem abnormalities is a basilar artery occlusion until proven otherwise. You will need a stat CTH and CTA brain/neck.

Cancer History
Type of cancer: _______
Date diagnosed: _______

Evidence of metastatic disease to the CNS or elsewhere

Patient received whole brain radiation or intrathecal chemo

Patient currently on chemotherapy (CNS infection)

Chemotherapeutic regimen has neurologic adverse effects (i.e. CAR-T neurotoxicity, checkpoint inhibitor)

Establish premorbid status
Where and with whom does the patient currently live?
What is their baseline cognitive and functional status?

Prior workup completed

Prior Brain Imaging

Prior EEG

Prior LP

Bedside cognitive testing (MOCA, SAGE, MMSE)

Establish the timeline

Symptoms started prior to hospitalization

Symptoms started during hospitalization

Symptoms are episodic

Differential Diagnosis

Septic Encephalopathy

Current sepsis or systemic infection

Toxic Encephalitis

Drug/alcohol withdrawal, Wernickes

Serotonin syndrome (recent serotonergic med changes)

NMS (recent dopamine blocker changes)

Med side-effects: recent steroids, benzos, anticholinergics, opiates, etc.

Cefepime-related neurotoxicity: recent cefepime use with new or worsening renal function

Hepatically metabolized meds (benzos, barbiturates, etc.) in a patient with new/worsening liver dysfunction

Stroke

Recent surgery (peri-operative stroke)

New or chronic afib

Periods of severe HTN

Periods of hypotension (watershed infarcts)

ICH, PRES

Periods of severe HTN

Hypoxic Brain Injury

Periods of hypoxia or hypercarbia

Metabolic Encephalopathy

New or worsening hepatic or renal impairment

Severe hyponatremia, hypercalcemia, hypomagnesemia, hypo/hyperglycemia

Dietary restrictions, gastric bypass, eating disorder, alcoholism, hyperemesis, poor PO intake, or chronically ill (deficiencies of B1/B12, copper, folate, vitamin E)

History of thyroid disease

Paraneoplastic Encephalopathy

Subacute symptoms

Infectious

Sexually active, history of STI (HIV, neurosyphilis)

Sleep Apnea

Choking/gasping for air during sleep

Daytime sleepiness

Dementia

Chronic slowly progressive

AMS-Specific Review of Systems

Headache (CNS infection, PRES, vasculitis)

Abnormal movements, seizure-like activity, convulsions

Episodes of altered awareness

Diplopia

Dysarthria

Dysphagia

Numbness/Tingling

Weakness

Incoordination

Lightheadedness

Vertigo

Falls/Change in gait

Need for ambulation device

AMS With Active Cancer

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