BMJ Case Reports 2017; doi:10.1136/bcr-2017-222253
  • Unexpected outcome (positive or negative) including adverse drug reactions

Unusual cause of encephalopathy after brain surgery

  1. Faiz U Ahmad2
  1. 1School of Medicine, Emory University, Atlanta, Georgia, USA
  2. 2Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
  1. Correspondence to Dr Faiz U Ahmad, faiz.ahmad{at}
  • Accepted 21 November 2017
  • Published 1 December 2017


For patients who have had a recent neurosurgical procedure, a visit to the emergency department for encephalopathy may automatically prompt a neurosurgical consult. We present a case of a patient with a history of Chiari malformation decompressed 6 months prior who presented with a 2-week history of slowly progressive altered mental status, headache and imbalance—symptoms consistent with her initial Chiari symptoms, so neurosurgery was consulted. Imaging showed no acute abnormality, but laboratory results revealed metabolic acidosis with high salicylate levels. When reporting medication use, this patient initially left out that she had been taking Goody’s powder (845 mg aspirin) for headaches, and long-term use led to metabolic encephalopathy. Despite a recent history of surgery, it is important to keep the differential diagnosis broad especially when there are signs of metabolic derangement.


  • Contributors ZM was involved in the written content. JGM was involved in the written content and reviewing and editing the manuscript. JSW was involved in the patient care and reviewing the manuscript. FUA was responsible for reviewing and editing the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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