Confused about Confusion

During morning rounds, the hematologist on call noticed confusion in a 49-year-old female patient. She had been admitted 5 days earlier for CD19-directed chimeric antigen receptor T-cell (CAR-T) therapy with infusion of axicabtagene ciloleucel for relapsed diffuse large B-cell lymphoma. Although the patient had been able to have a normal conversation the previous day, on this morning the hematologist found her to have bradyphrenia and to be disoriented to time and place. She had difficulty writing and counting backward. No signs of headache, vomiting, focal deficits, vision abnormalities, hallucinations, pain, changes in bowel or bladder function, cough, or shortness of breath were noticed. No trauma or seizure was observed. Vital signs, including temperature, were normal. A neurologic examination was notable only for disorientation and for slow speech with difficulty in putting words together, with no focal abnormalities. The rest of her physical examination was normal.

Automated summary

A female patient developed confusion and disorientation after receiving CAR-T therapy, with no other abnormal findings.