Confusion/ Memory Loss

Question 1

Key history for confusion and memory loss

Answer 1

• Must include hx from family members when available
• Detailed time course of cognitive deficits (acute v. Chronic/gradual onset)
• Assoc. Symptoms (constitutional, incontinence, ataxia, hypothyroid symptoms, depression)
• screen for delirium (waxing/waning level of alertness)
• FALLS
• Medication (any new changes?)
• hx of stroke or cardiovascular disease
• syphilis
• HIV risk
• alcohol use
• vit. B12 deficiency
• family hx of Alzheimer’s

Question 2

Key physical exam for confusion/ memory loss

Answer 2

1. Vital signs
2. Complete neurologic exam
3. Mini-mental and gait
4. ENT
5. Heart
6. Lungs
7. Abdomen
8. Extremities

Question 3

81 y.o. M presents with progressive confusion for the past several years accompanied by forgetfulness and clumsiness. He has a history of hypertension, DM, and 2 strokes with residual left hemiparesis. His mental status has worsened after each stroke (stepwise decline in cognitive function)

Answer 3

Dx

1. Vascular (multi-infarct) dementia
2. Alzheimer’s disease
3. Normal pressure hydrocephalus
4. Chronic subdural hematoma
5. Intracranial neoplasm
6. Depression
7. B12 deficiency
8. Neurosyphilis
9. Hypothyroidism

Question 4

Vascular dementia work up

Answer 4

1. CBC
2. VDRL/RPR
3. Serum B12
4. TSH
5. MRI- brain
6. CT- head
7. LP-CSF analysis

Question 5

84 y.o. F brought by her son c/o forgetfulness (ex. Forgets phone numbers, loses her way home) and difficulty performing daily activities (bathing, dressing, managing money, using the phone). The problem has progressed gradually over the past few years.

Answer 5

Dx.

1. Alzheimers
2. Vascular dementia
3. Depression
4. Hypothyroidism
5. Chronic subdural hematoma
6. Normal pressure hydrocephalus
7. Intracranial neoplasm
8. Depression
9. B12 deficiency
10. Neurosyphilis

Question 6

Alzheimer’s work up

Answer 6

1. CBC
2. VDRL/RPR
3. Serum B12
4. TSH
5. MRI- brain
6. LP- CSF analysis

Question 7

72 y.o. M presents with memory loss, gait disturbance, and urinary incontience for the past 6 months.

Answer 7

Dx.

1. Normal pressure hydrocephalus
2. Alzheimer’s disease
3. Vascular dementia
4. Chronic subdural hematoma
5. Intracranial neoplasm
6. Depression
7. B12 deficiency
8. Neurosyphilis
9. Hypothyroidism

Question 8

Normal pressure hydrocephalus work up

Answer 8

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

Question 9

55 y.o. M presents with a rapidly progressive change in mental status, inability to concentrate, and memory impairment for the past 2 months. His symptoms are associated with myoclonus, ataxia, and a startle response.

Answer 9

Dx.

1. Creuzfelt-Jakob disease
2. Vascular dementia
3. Levy body dementia
4. Normal pressure hydrocephalus
5. Chronic subdural hematoma
6. Intracranial neoplasm
7. Depression
8. Delirium
9. B12 deficiency
10. Neurosyphilis

Question 10

Creutzfeldt-Jakob disease work up

Answer 10

1. CBC
2. Electrolytes/ calcium
3. Serum B12
4. VDRL/RPR a
5. MRI- brain
6. EEG
7. LP- CSF analysis
8. Brain biopsy

Question 11

70 y.o. Insulin dependent diabetic M presents with episodes of confusion, dizziness, palpitations, diaphoresis, and weakness

Answer 11

Dx.

1. Hypoglycemia
2. TIA
3. Arrhythmia
4. Delirium
5. Angina

Question 12

Hypoglycemia work up

Answer 12

1. Glucose
2. CBC
3. Electrolytes
4. CPK-MBABANE, troponin
5. Echo
6. ECG
7. MRI- brain

Question 13

55 y.o. F presents with gradual altered mental status and headache. 2 weeks ago she slipped, hit her head on the ground and lost consciousness for 2 minutes

Answer 13

Dx.

1. Subdural hematoma
2. SIADH (causing hyponatremia)
3. Creutzeldt-Jakob disease
4. Intracranial neoplasm

Question 14

Subdural hematoma work up

Answer 14

1. CT- head
2. CBC
3. Electrolytes
4. MRI- brain
5. LP-CSF analysis