Good morning. My 77 y/o mother in law has very recently been admitted with signs of possible stroke: acute mental confusion, loss of memory and orientation, slight weakness. After a very complete workup, including labs, CT, MRI, CXR and neuro exam, no stroke has been indicated. MRI showed only normal, expected, age-related changes. Labs were normal except for mild anemia. Dementia appears to be the diagnosis by exclusion. I this is in fact her condition, we'll do whatever is necessary, but we want to be sure that is in fact her final dx, and that there is no underlying metabolic condition causing this that could be reversed.
She allegedly (this has come from her over the years, but she's never been the best medical historian) has been diagnosed by someone as hypothyroid, despite normal labs, and put on Synthroid. However, as she has been very independent, we haven't felt it necessary to monitor her med intake and we now have discovered that she apparently stopped her synthroid 2-3 years ago.
Some symptoms: likely brittle nail, itchy scalp and dry skin, intermittent complaints of serious head pain (same area), thinning hair, minimally forgetful and agitated (thought that was just her being difficult).
Our point of confusion is that this came on so acutely that it doesn't seem like a metabolic issue would do that. She had been fine, if not with some age appropriate issues, until 3 days ago, when we found her extremely altered, hence the ER visit and subsequent admission. Her S/S prompting the ER were: didn't know if it was day or night, no memory of doing things during the day, didn't remember her birthday, the year, the president (she watches CNN obsessively), where she lived (she lives in a separate apartment in our home), and more. She still admits to being confused and feeling off. She also is apparently sundowning, which could account for the acute S/S.
Can such acute S/S occur in hypothyroidism? Is there any way to identify a possible metabolic cause for these S/S? Other labs to run despite normal TSH and T4? I've also read that adrenal disease can mimic/produce dementia.
We're at the point of discharge within a day, likely to a rehab facility, and we do not want her to get lost in the system with the dementia tag, if it can be reversed through proper diagnosis.
Thanks to anyone. No idea if my email can post, but if you'd like, my direct email is ***@****. I understand and acknowledge that any information provided by medical professionals in response to this forum in no way represents treatment or a medical opinion, and is only provided for informational purposes. We're all alone caring for her, with no support system, so if there's a chance that this can be corrected, we'll consider anything.