Minicase - Confusion/Memory Loss

Question 1

W/u for vascular dementia (7)

Answer 1

1. CBC
2. VDRL/RPR (neurosyphilis)
3. Serum B12 (B12 deficiency)
4. TSH (hypothyroidism)
5. MRI brain (vascular dementia, neoplasm)
6. CT head (subdural hematoma, vascular dementia, NPH)
7. LP w/ CSF analysis

Question 2

W/u for Alzheimer disease (7)

Answer 2

1. CBC
2. VDRL/RPR (neurosyphilis)
3. Serum B12 (B12 deficiency)
4. TSH (hypothyroidism)
5. MRI brain (vascular dementia, neoplasm)
6. CT head (subdural hematoma, vascular dementia, NPH)
7. LP w/ CSF analysis

Question 3

W/u for NPH (6)

Answer 3

1. CT head
2. MRI brain
3. LP w/ CSF analysis and opening pressure
4. Serum B12
5. VDRL/RPR
6. TSH

Question 4

W/u for CJD (9)

Answer 4

1. CBC
2. Lytes, calcium
3. Serum B12
4. VDRL/RPR
5. MRI brain (neoplasm)
6. CT head (NPH, subdural hematoma)
7. EEG (CJD)
8. LP w/ CSF analysis
9. Brain biopsy

Question 5

W/u for hypoglycemia (11)

Answer 5

1. glucose
2. CBC
3. lytes
4. TSH
5. CPK-MB, troponin
6. ECHO (angina, arrhythmia)
7. EKG (angina, arrhythmia)
8. MRI brain
9. doppler U/S carotid (TIA)
10. Utox (medication-induced)

Question 6

W/u for subdural hematoma (6)

Answer 6

1. CT head
2. CBC
3. lytes
4. TSH
5. MRI brain (neoplasm)
6. LP w/ CSF analysis (CNS infection)

Question 7

Hx of multi-infarct dementia (4)

Answer 7

1. confusion/memory loss
2. timeline: long-term decline over years
3. PMHx: DM, HTN, strokes
4. stepwise decline in cognitive function
5. elderly

Question 8

Hx of Alzheimer disease (5)

Answer 8

1. confusion/memory loss
2. elderly
3. gradual progression over years
4. forgetfulness
5. difficulty with ADLs

Question 9

Hx of NPH (5)

Answer 9

1. confusion/memory loss
2. elderly
3. gait disturbane
4. urinary incontinence
5. timeline shorter (~ 6mo)

Question 10

Hx of CJD (6)

Answer 10

1. confusion/memory loss
2. rapidly-progressive change (~2mo)
3. inability to concentrate
4. myoclonus
5. ataxia
6. startle response

Question 11

Hx of hypoglycemia

Answer 11

1. confusion/memory loss
2. PMHx DM (w/ insulin)
3. episodic
4. confusion
5. dizziness
6. palpitations
7. diaphoresis
8. weakness

Question 12

Hx of subdural hematoma

Answer 12

1. confusion/memory loss
2. gradual AMS
3. HA
4. hx of head trauma (~2wks)

Question 13

Exams to consider (5)

Answer 13

1. vital signs (which should be given)
2. full neuro exam
3. MMSE
4. gait
5. general physical (heart, lungs, abd, extremities)

Question 14

Main ddx of confusion/memory loss (6)

Answer 14

1. vascular dementia
2. Alzheimer disease
3. NPH
4. Creutzfeldt-Jakob disease
5. hypoglycemia
6. chronic subdural hematoma