robin082006
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A 66-year-old female is brought to you by her concerned son. She has increasing confusion with loss of mobility and stiff limbs. She does not have any problems with her joints. She tends to cry out for no reason. She often screams and says that she is seeing a lion roaring in the backyard. In addition, she often sees cats in her room, even though there are none. She was treated with haloperidol, but that aggravated her rigidity. She also has significant memory loss. She is a non-smoker. She has no significant past psychiatric history. She is alert, but disoriented and quite agitated. On examination, increased tone and normal reflexes with coarse resting tremors are noted in the extremities. Her visuospatial abilities are quite impaired. Her vitals are, BP: 136/72 mm of Hg; PR: 98/min; RR: 16/min. Her CBC, electrolytes, creatinine, glucose, LFTs, TSH and B12 levels are within normal range. Serology for syphilis is negative. Based on this history and examination what is the most likely diagnosis?
A. Lewy body dementia
B. Alzheimer’s disease
C. Multi infarct dementia
D. Neurosyphilis
E. Pick’s disease
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| sarika
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A. Lewy body dementia
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| prathapdoctor
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A,LEWY BODY DEMENTIA, that is the reason why its aggravated by treatment with haloperidol, an antipsychotic with prominent antidopamenergic activity.
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| ssrpk
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agree with A
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| webjeee
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Agree with prathapdoctor.
patients with DLB are especially sensitive to drug-induced parkinsonism (DIP) when exposed to any dopamine blockers.
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| elitoki
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A
Lewy body dementia is associated with haluciantions.
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| RitaM
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Lewy body associated with visual hallucinations
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| genbot
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Answer is A
This is a classical case of Lewy body dementia...
Parkinsonism + visual hallucinations = Lewy body dementia
Additionally they also have associated Capgras syndrome and a poor response to antiparkinsonian medications which might infact precipitate symptoms of delirium in them.
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