Neurologic Emergencies at the Extremes of Age

Dementia and epilepsy following COVID-19 infection in a 25-year-old female: A case report

Significant atypical neurologic signs have also been recorded in COVID-19 individuals, along with a variety of other extra-pulmonary indications. The COVID-19 virus is neuro-invasive and holds significant potential to produce some unconventional neurologic manifestations.

Tuberculous meningitis in the elderly

OBJECTIVE

Although the elderly population remains at high risk for tuberculosis, studies addressing tuberculous meningitis (TBM) in this age group are scarce. The present study aimed to evaluate the spectrum and outcome of geriatric TBM and document differences between older and young patients.

METHODS

A prospective cohort study was conducted in the adult TBM patients admitted at PGIMER, Chandigarh (India). Consecutive older patients aged 60 years and above were enrolled from January 2019 to December 2020, and young adults aged 18-59 years were enrolled from July 2019 to December 2019.

RESULTS

Fifty-five older patients with a mean age of 66.6 years and 73 young patients with a mean age of 35.1 years were enrolled. At admission, older patients were more likely to have altered mental status (96.4% vs. 78.1%, P = 0.003) and advanced disease with British medical research council staging 2 or 3 (98.2% vs. 89.0%, P = 0.043); however, headache (38.2% vs. 67.1%, P = 0.001), vomiting (18.2% vs. 35.6%, P = 0.030) and fever (80.0% vs. 91.8%, P = 0.052) were less common. Cerebrospinal fluid (CSF) abnormalities were less marked in older patients, with a significant difference in median total cells (70 vs. 110/µl, P = 0.013). Hydrocephalous and infarct were common neuroimaging abnormalities in both groups; however, tuberculomas were significantly less in the elderly (15.1% vs. 35.2%, P = 0.012). Older patients had a significantly low survival rate (56.4% vs. 76.7%, P = 0.021).

CONCLUSION

Significant differences in clinical, CSF and radiological characteristics exist between elderly and young TBM patients, with survival remains dismal in the elderly.

Asymptomatic But Altered? When Urinalysis Holds the Key

Altered mental status (AMS) is a common symptom in geriatric patients, especially in the long-term care setting. Traditionally, AMS has been associated with urinary tract infections (UTIs) in older people. However, data correlating UTIs with AMS are lacking. For this reason, asymptomatic bacteriuria (ASB) guidelines do not recommend using non-specific symptoms, such as AMS, to indicate a potential diagnosis of UTI. It is important to distinguish between colonization and infection, which can be done through proper interpretation of a urine analysis in the presence of UTI-specific symptomatology. In the absence of UTIspecific symptoms, alternative diagnoses for AMS should be explored. Consultant pharmacists are a key stakeholder and partner in ensuring appropriate antimicrobial prescribing practices, including identification of ASB in older patients.