An older woman w/ lupus, sjogrens, MS, and recent resection of a parathyroid adenoma presents with AMS and fever to 103. She had an LP with only 7 WBCs, and her symptoms (and fever) quickly improved before receiving antibiotics. She was ultimately treated for ~24h with acyclovir, but given her rapid improvement she was discharged to home on HD1 with the thought that this was all due to a transient viral infection, though lupus cerebritis was also considered.
*The mnemonic for AMS is my favorite mnemonic of all. I use it every time to make sure I’m not missing anything.
The mnemonic: MOIST (or MISTO for people that hate that word)
M etabolic (uremia, Na, Ca, thyroid, glucose)
O xygen + hypercarbia (get that blood gas)
S tructural (stroke, subdural, seizure)