CONFUSION / MEMORY LOSS

Question 1

81 yo M presents with progressive
confusion over the past several
years together with forgetfulness
and clumsiness. He has a history of
hypertension, diabetes mellitus, and two
strokes with residual left hemiparesis. His
mental status has clearly worsened after
each stroke (stepwise decline in cognitive
function).

Answer 1

Differential WORK UP

Vascular (“multi-infarct”) dementia CBC
Alzheimer’s disease VDRL/RPR
Normal pressure hydrocephalus Serum B12
Chronic subdural hematoma TSH
Intracranial tumor MRI—brain
Depression CT—head
B12 deficiency LP—CSF analysis (rare)
Neurosyphilis
Hypothyroidism

Question 2

84 yo F brought by her son c/o
forgetfulness (e.g., forgets phone
numbers, loses her way back home) along
with difficulty performing some of her
daily activities (e.g., bathing, dressing,
managing money, using the phone). The
problem has gradually progressed over
the past few years.

Answer 2

Alzheimer’s disease CBC
Vascular dementia VDRL/RPR
Depression Serum B12
Hypothyroidism MRI—brain(prefered)
Chronic subdural hematoma CT—head
Normal pressure hydrocephalus LP—CSF
Intracranial neoplasm analysis(rare)
B12 deficiency
Neurosyphilis

Question 3

72 yo M presents with memory loss, gait
disturbance, and urinary incontinence for
the past six months.

Answer 3

Normal pressure hydrocephalus CT—head
Alzheimer’s disease LP—opening pressure &
Vascular dementia CSFanalysis
Chronic subdural hematoma Serum B12
Intracranial neoplasm VDRL/RPR
Depression TSH
B12 deficiency
Neurosyphilis
Hypothyroidism

Question 4

55 yo M presents with a rapidly
progressive change in mental status,
inability to concentrate, and memory
impairment for the past two months. His
symptoms are associated with myoclonus
and ataxia.

Answer 4

Creutzfeldt-Jakob disease CBC, electrolytes, calcium
Vascular dementia Serum B12
Lewy body dementia VDRL/RPR
Wernicke’s encephalopathy MRI—brain (preferred)
Normal pressure hydrocephalus CT—head
Chronic subdural hematoma EEG
Intracranial neoplasm LP—CSF analysis
Depression Brain biopsy
Delirium
B12 deficiency
Neurosyphilis

Question 5

70 yo insulin-dependent diabetic M
presents with episodes of confusion,
dizziness, palpitation, diaphoresis, and
weakness.

Answer 5

Hypoglycemia Glucose
Transient ischemic attack CBC, electrolytes
Arrhythmia Echocardiography
Delirium ECG
Angina MRI—brain
Doppler U/S—carotid

Question 6

55 yo F presents with gradual altered
mental status and headache. Two weeks
ago she slipped, hit her head on the
ground, and lost consciousness for two
minutes.

Answer 6

Subdural hematoma Electrolytes
SIADH (causing hyponatremia) CT—head
Creutzfeldt-Jakob disease MRI—brain
Intracranial neoplasm LP