Brief Answer:
Epilepsy and falls risk- ambulatory difficulties

Detailed Answer:
Good evening. Thank you for your question regarding your brother. Your 64 year old has a history of meningitis from when he was infant which has resulted in a seizure disorder resulting in his getting a lobectomy last February. Due to chest pain last week he was taken to the ER and found to have normal blood work. You say a CT was done (of the head I'm assuming) and was unremarkable. He has been losing his balance and finds it difficult to ambulate (assuming due to balance problems?) for the past few weeks. He goes into a deep sleep early in the evenings for the past few weeks as well. The patient ingests 6 cups of coffee, 5 cans of pop, and smokes which was said to cause him to "crash" in the evening. You are not sure but believe he may have an ear infection.

I believe the condition of your brother has changed over the past few weeks. You are correct in wanting to rule out the most simple things first such as an ear infection, urinary tract infection, or even subtle respiratory infection. Any of those things could potentially cause him to have dysequilibrium and loss of balance causing him to fall and potentially hurt himself.

I do not quite buy the explanation of his going to bed earlier than usual simply based upon a hypothetical caffeine rush followed by crash. He's been doing that sort of thing, likely all his life..I don't think that suddenly out of the blue it would cause these sorts of issues.

However, another thing to consider once infectious sources have been ruled out would be something "neurologically simple" such as HYDROCEPHALUS which could be alleviated by spinal fluid withdrawal in the form of an intracranial pump and drain. With his history of meningitis, mental slowness, seizures, and age 64 I would be very surprised if he didn't have a significant dilation of his ventricular system leading to hydrocephalus ("water on the brain") and again, this may not be something that would've been easily picked up if it has been building over a period of time. Or perhaps, it is mild and he has been compensating but because there is the possibility of an infectious source...maybe that was enough to exaggerate his symptoms and "push him over the edge."

At any rate I don't see the need for you to travel with him to the ER at this point. Simply watch over him and make sure he gets accompanied to the bathroom or wherever he goes around the house. Accompany him up and down stairs (preference would be to avoid steps altogether).

Also, if he has not had routine labs to include TSH, FT4, and cortisol levels these may be worthwhile getting as well as testosterone levels which are probably low and could contribute to more balance and cognitive dysfunction/lethargy if it is indeed significantly low...so I would have those labs checked.

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