Angel's Trumpet 25F
ADMIT: 3/6/26
TEAM: LAVENDER

CODE: FULL
DX: TEMPORAL LOBE EPILEPSY W/ FOCAL IMPAIRED-AWARNESS SEIZURES AND POST-ICTAL BEHAVIORAL CHANGES

• p/w altered mental status, unexplained neurologic symptoms, intermittent tachycardia, and multiple bizarre complaints
• reported hearing her speaking loudly to herself in what sounded like multiple different accents and languages. pt was found sitting cross-legged on the kitchen floor surrounded by jars of soil labeled with dates and locations. in the ED pt was alert but extremely odd, alternating between being very polite and soft-spoken and then suddenly speaking in a formal, archaic tone like she was narrating a historical documentary.
• also reports sleeping approximately 2 hours per night for the past week because pt has been: "mapping the acoustic structure of caves.”
• psych was consulted but hesitant to label this primary psychiatric because the patient has intermittent neurologic findings.
• differential diagnosis: psychosis vs. complex partial seizures vs. sleep deprivation

ACTIVITY: Ambulatory
DIET: Regular
IV: L FA 20 G w/Cont. NS @ 75 mL/hr
NEURO: A & O x2, disoriented to time and situation at times. intermittently refuses to answer questions unless they are phrased in what she calls “poetically appropriate language.”
PULMO: Room air
CARDIAC: Tele: sinus tachy w/ occasional PACs
GI: BRP LBM: 3/5
GU: BRP
SKIN: Intact w/tattoo
V/S: VSS w/Tachycardia.
PLAN: Neuro consult pending, Continuous IVF, telemetry, EEG, MRI Brain, encourage sleep hygeine

LABS:

• UTox: Negative
• CT Head: Negative
• WBC: 12