CASE 90
A 46-year-old man presented with a 6-month history of increasing forgetfulness, depression, and personality changes. Electroencephalographic (EEG) examination and head CT scan were unremarkable, and no specific diagnosis was made. A few months later, he was hospitalized for increasing confusion, ataxia, and movement tremors of his extremities.
LABORATORY STUDIES
Diagnostic Work-Up
Table 90-1 lists the likely causes of the patient’s illness (differential diagnosis). Investigational approach may include
TABLE 90-1 Differential Diagnosis and Rationale for Inclusion (consideration)
Rationale: Dementia may be due to many etiologies, which are often difficult to distinguish clinically. Gradual onset over a period of years usually suggests Alzheimer disease. Metabolic encephalopathies should always be considered because they are frequently reversible; tumors may be treatable. SSPE and prion-associated diseases are not treatable, are more difficult to diagnose, and have important prognostic implications.
COURSE
Lumbar puncture was performed; blood culture and all analyses on CSF, including cultures, were negative for any infectious etiology. The patient’s clinical con- dition progressively worsened; a panic attack was diagnosed, and the patient was treated with an antianxiety medication.
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