Seelig Sandra, Ryus Caitlin R, Harrison Raquel F, Wilson Michael P, Wong Ambrose H
Department of Emergency Medicine, Yale-New Haven Hospital, New Haven, Connecticut.
Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
J Emerg Med. 2019 Aug;57(2):203-206. doi: 10.1016/j.jemermed.2019.03.016. Epub 2019 Apr 20.
Organic conditions can often mimic neuropsychiatric disorders, leading to delays in diagnosis and treatment for the most vulnerable populations presenting to the emergency department (ED).
Here we discuss a case of cryptococcal meningoencephalitis seemingly consistent with psychosis on initial evaluation, and present strategies to recognize and treat this condition. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Due to the indolent time course of this disease, initial symptoms of altered mental status and personality changes may be attributed to drug use or psychiatric illness before more overt evidence for increased intracranial pressure and neurologic infection develops. It is important for emergency clinicians to maintain a high level of suspicion for this condition in at-risk patients and reassess them frequently during their ED visit.
器质性疾病常可模仿神经精神障碍，导致急诊科就诊的最脆弱人群的诊断和治疗延误。
在此，我们讨论一例最初评估时看似与精神病相符的隐球菌性脑膜脑炎病例，并介绍识别和治疗这种疾病的策略。急诊医生为何应了解此情况？：由于该疾病进展缓慢，在颅内压升高和神经感染的更明显证据出现之前，精神状态改变和人格变化的初始症状可能归因于药物使用或精神疾病。对于急诊临床医生而言，对高危患者保持高度怀疑并在其急诊科就诊期间频繁重新评估他们非常重要。
