doyoudig
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A 72-year-old man is brought to the physician
by his son because of a 4-day history of increasing confusion and memory problems. The son says that his father's ability to function
independently has been generally declining over the past few years, and he has become much more impaired over the past week. The patient has had at least three to four previous episodes of a sudden decline of cognitive functioning over the past 3 years without full recovery. He has a history of hypertension. His blood pressure is 160/95 mm Hg without orthostatic changes. Neurologic examination shows no focal findings.
Mini-Mental State Examination score is 21/30. Which of the following is the most likely underlying pathophysiologic process?
A) Central nervous system demyelination
B) Central nervous system infection
C) Diffuse axonal injury
D) Diffuse cortical atrophy
E) Left temporal lobe infarction
F) Multiple, small, central nervous system
infarctions
G) Subdural hematoma
DDDDDDDDDDDDDDDD or FFFFFF
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| robin082006
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F<--- at least three to four previous episodes of a sudden decline of cognitive functioning over the past 3 years without full recovery.
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| doyoudig
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but if you say "three to four previous episodes of a sudden decline of cognitive functioning over the past 3 years without full recovery."
what about
1. There is No Focal Signs on Neuro Exam
2. There is only Hx of decline in Cognitive Function, no sensory/motor problems
How can we explain this?
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| cirus
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agree with Robin..
step wise decline is due to recurrent small CVA that may be passed un-noticed.
abscence of focal neuro doesn't exclude it as it can present without focals..
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| Justice
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F
small infarctions may result only in transitory Focal Signs with sensory/motor problems
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| doc_clotaire
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Agree with F
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| dr in trouble
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Multi infarct dementia--F
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| khorshid
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F
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| Drtweetie
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(F)--multi-infarct dementia
There's no motor/sensory impairment on exam, but his cognitive function has declined, evidenced by low MMSE score.
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