An elderly patient admitted with acute ischemic stroke. While in the hospital, his conscious level worsened. Neuro imaging did not suggest any cause for worsening. His laboratory parameters were as follows- serum sodium 118, blood urea= 31, plasma glucose=117. His urine output was 3200 ml. Patient’s family is keen know to cause of his ill health. How will you investigate further?

Acute ischemic stroke in elderly patients often presents with various complications, including altered consciousness. When a patient's conscious level worsens despite stable neuroimaging findings, it raises concerns for other underlying causes. In such cases, a thorough investigation is crucial to determine the underlying etiology and provide appropriate management. This essay aims to outline a systematic approach to investigating altered consciousness in an elderly patient with acute ischemic stroke, focusing on clinical geriatrics perspectives.

Initial Assessment:

Before delving into specific investigations, a comprehensive assessment of the patient's clinical status is essential. This includes a detailed history taking, physical examination, and review of available investigations. Key aspects to evaluate include the patient's neurological status, vital signs, fluid balance, medication history, comorbidities, and recent interventions.

Laboratory Parameters:

The provided laboratory parameters offer valuable insights into the patient's condition:
1. Serum Sodium: 118 mEq/L (Hyponatremia)
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