Cognitive Problems

Question 1

78 year old woman becomes abusive to neighbors, loses vibration sense over distal legs, and has absent ankle reflexes and pupils which react to accommodation but not to light

Answer 1

Neurosyphilis

Question 2

67 year old man with transient four hour memory loss and odd behavior

Answer 2

Transient global amnesia

Question 3

Healthy 30 year old man with 2 days of disorientation, inability to remember new information, and agitation, and FLAIR abnormalities in both hippocampi on MRI

Answer 3

Paraneoplastic disorder (Anti-Ma, associated with testicular cancer) vs. herpes encephalitis

Question 4

58 year old executive with difficulty working and multi-tasking one month after CABG complicated by a-fib and wound infection

Answer 4

Hypoxic-ischemic encephalopathy, likely due to multiple micro-emboli during CABG, good prognosis