Confusion/Memory Loss Flashcards
What key history would you obtain from a patient who has confusion or memory loss?
Must include history from family members/caregivers
Detailed time course of cognition deficits
Associated symptoms (constitutional, incontinence, ataxia, hypothyroid symptoms, depression)
Screen for delirium (waxing/waning level of alertness)
Falls
Medications (and recent changes)
History of stroke or other atherosclerotic valvular disease
Syphilis
HIV risk factors
Alcohol use
Vitamin B12 deficiency
Family history of Alzheimer’s disease
What key physical exams would you perform on a patient who had confusion or memory loss?
Vital signs
Complete neurological exam including mini-mental status exam and gait
General physical exam, including ENT, heart, lungs, abdomen and extremities
81 yo M presents with progressive confusion over the past several years together with forgetfulness and clumsiness. He has a history of hypertension, DM and two strokes with residual left hemiparesis. Mental status has clearly worsened after each stroke. Differentials?
Vascular ("multi-infarct") dementia
Alzheimer's disease
Normal pressure hydrocephalus
Chronic subdural hematoma
Intracranial tumor
Depression
B12 deficiency
Neurosyphilis
Hypothyroidism81 yo M presents with progressive confusion over the past several years together with forgetfulness and clumsiness. He has a history of hypertension, DM and two strokes with residual left hemiparesis. Mental status has clearly worsened after each stroke. Differentials: Vascular (“multi-infarct”) dementia, Alzheimer’s disease, normal pressure hydrocephalus, chronic subdural hematoma, intracranial tumor, depression, B12 deficiency, neurosyphilis, hypothyroidism. Workup?
CBC VDRL/RPR Serum B12 TSH MRI- brain CT - head LP - CSF analysis
84 yo F brought by her son complaining of 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. Differentials?
Alzheimer's disease Vascular dementia Depression Hypothyroidism Chronic subdural hematoma Normal pressure hydrocephalus Intracranial tumor B12 deficiency Neurosyphilis
84 yo F brought by her son complaining of 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. Differentials: Alzheimer’s disease, vascular dementia, depression, hypothyroidism, chronic subdural hematoma, normal pressure hydrocephalus, intracranial tumor, B12 deficiency, neurosyphilis. Workup?
CBC VDRL/RPR Serum B12 TSH MRI - brain (preferred) CT - head LP - CSF analysis (rare)
72 yo M presents with memory loss, gait disturbance and urinary incontinence for the past six months. Differentials?
Normal pressure hydrocephalus Alzheimer's disease Vascular dementia Chronic subdural hematoma Intracranial tumor Depression B12 deficiency Neurosyphilis Hypothyroidism
72 yo M presents with memory loss, gait disturbance and urinary incontinence for the past six months. Differentials: Normal pressure hydrocephalus, Alzheimer’s disease, vascular dementia, chronic subdural hematoma, intracranial tumor, depression,
B12 deficiency, neurosyphilis, hypothyroidism. Workup?
CT - head LP - opening pressure and CSF analysis Serum B12 VDRL/RPR TSH
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. Differentials?
Creutzfeldt-Jakob disease Vascular dementia Lewy body dementia Wernicke's encephalopathy Normal pressure hydrocephalus Chronic subdural hematoma Intracranial tumor Depression Delirium B12 deficiency Neurosyphilis
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. Differentials: Creutzfeldt-Jakob disease, vascular dementia, Lewy body dementia, Wernicke’s encephalopathy, normal pressure hydrocephalus, chronic subdural hematoma, intracranial tumor, depression, delirium, B12 deficiency, neurosyphilis. Workup?
CBC, electrolytes, Ca2+ Serum B12 VDRL/RPR MRI - brain (preferred) CT - head EEG LP - CSF analysis Brain biopsy
70 yo insulin-dependent diabetic M presents with episodes of confusion, dizziness, palpitation, diaphoresis, and weakness. Differentials?
Hypoglycemia Transient ischemic attach Arrhythmia Delirium Angina
70 yo insulin-dependent diabetic M presents with episodes of confusion, dizziness, palpitation, diaphoresis, and weakness. Differentials: hypoglycemia, TIA, arrhythmia, delirium, angina. Workup?
Glucose CBC, electrolytes Echocardiography ECG MRI - brain Doppler U/S - carotid
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. Differentials?
Subdural hematoma
SIADH (causing hyponatremia)
Creutzfeldt-Jakob disease
Intracranial tumor
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. Differentials: subdural hematoma, SIADH (causing hyponatremia), Creutzfeldt-Jakob disease, intracranial tumor. Workup?
Electrolytes
CT - head
MRI - brain
LP
