MAB
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72 y/0 woman complains of difficulty "finding the right word" when she is speaking.Her daughter notes that she also frequently notes that her neighbor is stealing her newspapers when this is not the case in actuality.Recently, the patient has been having difficulty balancing her checkbooks as well.BP=160/110,HR=90/min.The exam is otherwise unremarkable. Over the course of next 3 years, the patient develops severe memory deficit,and suffers from poor sleep,slowness of movement,shuffling gait and uriniary incontinence. What is the most likely diagnosis?
a) Alzheimer's dementia
b) Dementia with Lewy bodies
c) Multiinfarct Dementia
d) Vit. B12 Deficiency
e) Normal Pressure Hydrocephalus
f) Chronic Subdural Hematoma
g) Pseudodementia
h) Hypothyroidism
i) Thiamine Deficiency
j) Drug Induced Dementia
Please reply with short explaination...thanks
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| Eagle_303
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Dementia + Gait ataxia + Urinary incontinence is well known triad of NPH
Alzheimer = memory loss initial symptom
Multi -infarct dementia = step wise progression
Demential with lewy bodies = Extrapyramiddle effects are more marked
B12 deficiency = spinal cord symptoms of Subacute combined degeration with anemia is also present
Pseudodementia = depression (patient complains about memory loss not relatives while in true dementia patient does not complain about memory loss but relatives)
Best of luck
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| MAB
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thanks a lot Eagle_303,
but what is the answer in this case?
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| MAB
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correct answer is - Alzheimer's dementia.......I am surprised too.
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| Eagle_303
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If this is the answer ,then Terrible ------------------------LOL
Picture fits more in normal pressure hydrocephalus
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| MAB
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today only I found out why it is Alzheimers...
to be considerer as Normal pressure hydrocephalus...you need to do MRI and look for dilated ventricles.....
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| cherryho
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But this patient didn't have ataxic gait. At later stage AD patients can have incontinence too.
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| dr in trouble
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160/110 is not normal pressure, I was thinking about multiinfarct dementia but I think Alzheimers is more favorable.
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| Eagle_303
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dr in trouble wrote:
160/110 is not normal pressure, I was thinking about multiinfarct dementia but I think Alzheimers is more favorable.
Do you think that 160/110 is CSF pressure ?
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| MAB
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He/she is just confused between Blood Pressure and CSF pressure....
but..that doesn't matter...got the right answer anyways...
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