Beyond encephalitis: a case report

Abstract

Introduction: An acute confusional state reflects a sudden change in consciousness. The etiology is usually multifactorial and the diagnosis is more difficult in the elderly. It may be associated with many diseases, each with a different severity, management and prognosis. This case illustrates a rare presentation of a brain tumor as a confusional state. It demonstrates the role of the family physician as the main support for the patient and the family and the importance of continuity of care. Case report: A 69 year-old married man was brought to a consultation because of sudden behavioral changes and mental confusion, without fever. He was known to suffer from type 2 diabetes, arterial hypertension, cardiovascular disease, and obesity. He was referred to the emergency room, where he became febrile. Viral encephalitis was diagnosed. After a prolonged hospitalization, he returned home and became partially dependent. His recovery was slower than expected. A follow-up examination revealed a glioblastoma multiforme. The family had difficulty adjusting to the diagnosis and the dependent state of the patient. There were many visits to the emergency department and multiple complications. He died nine months later. Comments: Sudden illness, particularly when it changes the degree of dependence of the patient, requires adaptation by the family. The family physician had an important role to play in the management of this situation. He managed the initial presentation, provided support in the recovery from the acute illness, informed and educated and the patient and the family, made himself available to the family, cared for the patient, and supported the caregivers. However, the expectations of the family for a full recovery hindered communication between the health care team and the family. In this case, despite expert care by the physician, the fears and expectations of the patient and family can jeopardize a desired outcome.