From the Guidelines
Cause of Mental Status Change with Markedly Elevated ESR
The cause of a mental status change in the context of a markedly elevated Erythrocyte Sedimentation Rate (ESR) is most likely due to an inflammatory or infectious process.
- This can include conditions such as encephalitis, meningitis, or systemic infections that can cause a significant elevation in ESR and lead to mental status changes 1.
- A markedly elevated ESR is a non-specific indicator of inflammation and can be seen in various conditions, including autoimmune disorders, infections, and malignancies.
- In the context of mental status changes, it is essential to consider infectious encephalitis as a potential cause, which can present with fever, headache, and altered level of consciousness 1.
- The management approach for encephalitis involves early recognition, diagnostic evaluation, and emergent administration of antimicrobial agents, highlighting the importance of distinguishing between infectious and non-infectious causes of mental status changes 1.
- While neuroimaging with CT or MRI may be appropriate in certain cases, the yield may be low in the absence of trauma or a focal neurological deficit, emphasizing the need for a thorough clinical evaluation to guide management decisions 1.
From the Research
Causes of Mental Status Change with Elevated ESR
The cause of a mental status change in the context of a markedly elevated Erythrocyte Sedimentation Rate (ESR) can be attributed to various underlying conditions. Some of the possible causes include:
- Infections, which are the most common diagnoses associated with elevated ESRs 2, 3
- Malignancy, which can also cause elevated ESRs, although the frequency of this association varies across studies 2, 3, 4
- Rheumatologic disease, other inflammatory diseases, and renal disease, which can also contribute to elevated ESRs 2
- Systemic illness resulting in end-organ dysfunction of the brain, which can cause altered mental status 5
Diagnostic Approach
When evaluating a patient with a markedly elevated ESR and altered mental status, a comprehensive approach is necessary. This includes:
- A primary survey to identify immediate life-threatening conditions 5
- A secondary survey to search for other life-threatening or reversible causes 5
- A systems-based approach to evaluate for underlying conditions that may be contributing to the elevated ESR and altered mental status 5
- Laboratory and radiographic testing to support the diagnosis 5
Considerations in Elderly Patients
In elderly patients, elevated ESRs can have a similar pathological significance as in younger patients, but the clinical conditions may be more obscure 4. Therefore, it is essential to carefully investigate the cause of a high ESR in geriatric patients, even if they are asymptomatic 4.