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Old 09-11-2011
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Default Dementia Q

78 years old man, presented to ER with his wife, complaining of progressive memory loss for the last 6 month, CT scan of the head is normal, thyroid function is normal. What is the next step in the management of this patient?
  • 14-3-3 protein level in the CSF.
  • Brain biopsy.
  • CSF examination.
  • Look for B12 deficiency.
  • VDRL.

Last edited by ag2011n; 09-11-2011 at 06:16 AM. Reason: important information is missed
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Old 09-11-2011
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..not sure but i think it would be csf exam ..since the ct is normal
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Old 09-11-2011
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i think, next step will be ' look for B12 deficiency '
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Old 09-11-2011
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Quote:
Originally Posted by ag2011n View Post
78 years old man, presented to ER with his wife, complaining of progressive memory loss for the last 6 month, CT scan of the head is normal, thyroid function is normal. What is the next step in the management of this patient?
  • 14-3-3 protein level in the CSF.
  • Brain biopsy.
  • CSF examination.
  • Look for B12 deficiency.
  • VDRL.
Look for B12 deficiency. CSF is useful determining NPH but it is an invasive method and you should rule out all the medical causes of dementia first.
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Old 09-11-2011
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Quote:
Originally Posted by dryogi View Post
i think, next step will be ' look for B12 deficiency '
Agree. Should start with least invasive. Also recently found that owing to its common prevelence Medicare also covers vit B12 supplementation.
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Old 09-11-2011
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Less invasive first, so rule out B12, then VDRL.
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Old 09-11-2011
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The correct answer is : VDRL. Remember that although the differential list is really long, but as far as investigation you need to go: do the following
1. CT san head.
2. Thyroid function test.
3. Check for syphilis: RPR/VDRL.
4. Then evaluation for B12.
As we all know the important differential diagnosis of dementia includes:
1. Mild cognitive impairment ; Memory loss only.
2. Alzheimerís disease: Memory loss with loss of cognition. The most common cause in USA.
3. Frontotemporal dementia: pickís disease: loss of social appropriateness then memory loss, progressive nonfluent aphasia.
4. Lewy Body dementia: Parkinsonian symptoms + Hallucination.
5. Parkinsonís dementia: usually dementia is very late in the course of the disease.
6. CJD: very rapid course, progressive ataxia with Myoclonic jerks
7. Multi-infarct dementia: stepwise progression, the 2nd most common cause.
8. Binswanger disease: slowly progressive disase.
9. Normal pressure hydrocephalus: wobbly, wacky & wet.
The only cause of dementia that needs CSF for diagnosis JCD, the history is usually very clear with very rapid progressive dementia with Myoclonic jerks & ataxia, the time from diagnosis to death is around 6 month.
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