What on Earth is this - FIL?

[Godstopper]

Hi All,

I thought I'd try and get some general advice here as no-one really knows what is going on, and we will be talking to Dr's soon. Situation involves my 75 year old father-in-law. Whatever is going on has played out like this:

• Returned from holiday about a month ago (in U.K) and began feeling lethargic as well as noticing high BP (he checks it regularly due to being diabetic). GP gives him pills.
  

• Loses appetitie, begins sleeping away much of the day in a chair. Occasional confusion. Increased BP. Back to G.P. Change of pills.
  

• Keeps deteriorating. Woke up at 6 am the other morning and began pushing and shoving my mother-in-law, crawling around, and fell in the bath completely incoherent! MIL called an ambulance and he's now in hospital.
  

• BP keeps going up to 220 over something. He had a CT scan which was clear.
  

• Something about his pupils being different sizes on occasion.
  

• He's been started on antibiotics as the Dr. thought it may be a type of pneumonia or another virus. He's started drinking, but still doesn't really knows where he is - he's chatting away but talking nonsense. BP still not well controlled.
  

• Dr now says unsure what it might be. He's still in hospital as clearly not in a fit state to return home. Blood tests have been ran and we're waiting for results.
  

Has anyone gone through something like this? He was extremely sharp and relatively fit before this. What sort of virus would go on for a month and cause mental confusion? Is there anything we can ask the Dr's that might be useful? Thanks for any suggestions :)

[Anatidae]

Has he been checked for stroke/Subdural haematoma?

[Anatidae]

UTIs can also cause serious symptoms like confusion in older people.

The unequal pupils and confusion should have triggered a full set of neurological tests

[Godstopper]

Wouldn't the CT show up anything like a stroke? I don't really know.

Yes, my immediate thought as a layperson was IT'S HIS BRAIN! But all we know is that he's on hourly obs whilst waiting for blood test results. MIL is not the most assertive person in the world, hence getting some thoughts here before we speak to the Dr's.

[Anatidae]

Not everything resolves well on a CT - small strokes or small lesions in the brain stem can be missed pretty easily and sometimes damage elsewhere doesn’t show up immediately.

IF the doc is thinking infection that would suggest theyve seen something in the bloods to indicate a recent infection - viruses and viral pneumonia wouldn’t be helped by antibiotics of course. A UTI can lead to severe and rapid quite dramatic symptoms of confusion but antibiotics should nuke that (assuming correct type used.)

Not a medic btw - just a mere scientist ;)
I hope you get some good news...

What can you ask the doc? I’d start with:

Have you seen anything in the blood tests that would indicate infection?
Any signs of urinary tract infection?
Are there any out of range blood test results?
If so, what are they? Are they clinically significant?
What was seen in the CT?
What can’t you see on the CT? Will another one be done to look for damage?
Any signs of vascular dementia or vascular issues in the brain?

Where do we go from here? What do you You think it could be? What further tests will you run?

[Blackcatonthesofa]

Have his kidneys been checked? I guess so if he is diabetic but otherwise that could explain high bp. Older people can get confused when sick unfortunately.

[Godstopper]

Hiya,

Thanks so much for help both. I hadn't realised something like a UTI could also cause this.

The GP (before he took a dramatic turn) said something about changing his BP tablets as he thought the previous ones were affecting his kidneys in some way. His diabetes has always been reasonably well-controlled - some eye issues for which he has injections, but that's it.

Will update once more is known :)

[Butterymuffin]

I also thought UTI when I read this. It affected a relative of mine really badly both mentally and physically. Ask doctors about this.

[Ttbb]

My first thought would be a stroke. Was he sitting for a long time while travelling?

[PurpleAlerts]

My mum ( who suffered for a number of years with an autoimmune condition) once went very rapidly downhill with an infection. My dad came back from shopping and she was delirious, unable to walk and talking gobbledegook. She was taken to hospital and when I saw her a few hours later I thought she had had a stroke - she was completely gaga- didn't know who I was ,rambling nonsense. etc.

Turned out that she had a very serious infection ( not sure if it was a UTI) and they got her on some strong anti- biopics. 24 hours later she was still weak but totally with-it and had no memory of what had happened the day before.

[Godstopper]

Hi Ttbb,

Well yes, it's crossed my mind too, but it started off with vague symptoms that slowly became worse until he had a dramatic turn. I don't know if that fits with stroke. He wouldn't have been sitting for excessively long periods, I don't think - just a few hours at a time on a golfing holiday.

Yes Purple, your Mum sounds like how he is now. He's sleeping, and then wakes up to talk nonsense. He's been started on antibiotics (two days ago) but we have no real change as of yet.

[BeetrootTart]

Did he travel anywhere with tropical diseases/parasites?

[Godstopper]

Nope. Golfing holiday in the UK.

[starfishmummy]

Normal Pressure Bydrocephalus??
www.shinecharity.org.uk/hydrocephalus/about-hydrocephalus/normal-pressure-hydrocephalus

[Prokupatuscrakedatus]

Borreliose? I think it's called Lyme's desease?

The symptoms remind me of my DF - he regained the full use of his brain but not his legs.

[Godstopper]

Thanks again, I am noting these things down.

I forgot to mention that he had a number of unexplained bruises on him in the hospital. The suspicion is that he's been having falls but not telling anyone.

He does have some arterial blockages in his legs that has something to do with his diabetes, but does walk reasonable distances and had been building that up.

He recognises my MIL but then lapses into incoherent babble.

[LuluJakey1]

My uncle was like this and had a really persistent UTI. After courses of antibiotics over 6 months which would sudue it and then it would flare up again, he was hospitalised for a month before they finally sorted it out. He was 82 and as fit as a flea and pin sharp.

[Themummy76]

My guess would be something kidney related
The kidneys regulate bp

[Themummy76]

And I would say high bp causing stroke

[Themummy76]

I hope you get some answers soon. The not knowing is awful.

[FreezerBird]

Was going to suggest UTI or Normal Pressure Hydrocephalus, which I see have already been mentioned above.

I would hope that UTI would be investigated as a matter of course given the symptoms you describe, but the NPH is a bit more left-field and might be worth mentioning.

I read some research a while back (which obviously I can't find now...) and it's thought that a shockingly high number of nursing home patients have NPH rather than Alzheimer's or other types of dementia, but it's under-diagnosed.

[Godstopper]

Update: Something bacterial or viral attacking his brain. Not specific I know! Now a possible MRI and also having a lumbar puncture. Still in the dark.

[nothateasybeingreen]

Encephalitis? Used to work on a neuro unit and patients seemed to be typically young girls with a very specific form related to ovarian tumours or older people who often presented with general confusion and neuro symptoms. With the older people it was harder to pinpoint as it seemed so like dementia, but with the added neurological features if that makes sense (changes in pupils) and rapid onset. Encephalitis can make people behave in a very odd manner indeed. Aggression was a big one - people can develop incredible strength somehow. Think they used to treat with antivirals , antibiotics and immunoglobulin, plasma exchange, all sorts. Feel for you all

[Godstopper]

Nothing specific yet: he had the lumbar puncture yesterday, and Dr said if that's not conclusive he'll have an MRI. MIL says he seems to know he's speaking nonsense as if he's 'in there' and trying to get out. He's on a broad spectrum antibiotic, oxygen, and has been catheterised. Finally able to visit tomorrow and will hopefully have a diagnosis from the lumbar.

[Godstopper]

Update: Thanks so much for everyone's input. Notthateasy got it right. The lumbar revealed encephalitis (caused by the herpes virus my MIL reports). He's been hallucinating. However, within hours of a specific treatment for it he's become more lucid relative to what he was and says he has an "elephant-something-or-other."!

[Anatidae]

Blimey! Well good they’ve pinpointed it and are treating it. Let’s hope he has a quick and full recovery 👍