Differential Diagnosis for Altered Mental Status and Elevated Blood Pressure in a 51-Year-Old Female with Schizophrenia
Single Most Likely Diagnosis
- Hypertensive Emergency: Given the patient's elevated blood pressure and altered mental status, a hypertensive emergency is a strong consideration. The altered mental status could be due to hypertensive encephalopathy, which is a medical emergency requiring immediate blood pressure reduction.
Other Likely Diagnoses
- Neuroleptic Malignant Syndrome (NMS): The patient is on Abilify (aripiprazole), an antipsychotic that can cause NMS, a life-threatening condition. Symptoms include altered mental status, fever, muscle rigidity, and autonomic dysfunction, which could explain the elevated blood pressure.
- Serotonin Syndrome: Although less likely with Abilify, serotonin syndrome is a possibility, especially if the patient is on other serotonergic medications. It presents with altered mental status, autonomic instability (which could include hypertension), and neuromuscular abnormalities.
- Benztropine Side Effects: Benztropine, an anticholinergic used to treat extrapyramidal side effects of antipsychotics, can cause confusion, delirium, and other cognitive impairments, especially in older adults or at high doses.
Do Not Miss Diagnoses
- Intracranial Hemorrhage: A sudden onset of altered mental status and elevated blood pressure could indicate an intracranial hemorrhage, which is a medical emergency requiring immediate imaging and intervention.
- Infection (e.g., Sepsis): Infections can cause altered mental status and elevated blood pressure due to the body's systemic inflammatory response. Given the patient's immunocompromised state due to chronic illness and potential medication side effects, this is a critical diagnosis not to miss.
- Myocardial Infarction or Cardiac Ischemia: Although less directly related to altered mental status, cardiac events can cause autonomic instability leading to hypertension and, in severe cases, altered mental status due to decreased perfusion.
Rare Diagnoses
- Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic hypertension, which might be associated with altered mental status due to severe blood pressure fluctuations.
- Thyroid Storm: A life-threatening complication of untreated or undertreated hyperthyroidism, which can present with altered mental status, hypertension, and other systemic symptoms.
- Autoimmune or Paraneoplastic Encephalitis: Rare conditions that could explain altered mental status but would be less directly related to the elevated blood pressure unless causing systemic inflammation or autonomic dysfunction.