Pregunta 67. Cuál de los siguientes es crucial cómo seguiente paso en paciente con demencia progresiva?

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NEUROSAE 2018 ANNUAL MEETING EDITION (VOLUME 10, ISSUE 3)
QUESTION 67 OF 100

67.
A 42-year-old woman presents with a 3- to 4-month history of cognitive decline. The symptoms began insidiously but have rapidly increased since onset, prompting concerns for a subacute dementia. The patient has no history of systemic illness, including immunosuppression. In addition to basic laboratory studies and MR brain imaging, which of the following studies should be included in the initial diagnostic evaluation?

A. Serum drug screen
B. CT chest, abdomen, and pelvis with IV contrast
C. Brain biopsy
D. CSF 14-3-3 testing
E. Electroencephalography **
** = Your answer

Rapidly progressive dementia, while rare, presents a difficult diagnostic challenge. Many of the principles for working up patients with dementia apply in this situation, but the patient’s rapid decline and the extensive differential diagnosis requires a systematic approach be used, focusing on treatable and reversible conditions. Initial screening should include laboratory studies that address common conditions, including thyroid disease, vitamin B12 deficiency, and HIV. MRI of the brain, electroencephalopathy (EEG), and lumbar puncture also are appropriate initial tests. Depending on the specific clinical scenario, negative results of initial testing prompt the need for additional diagnostic testing. Of the options listed, only EEG is considered a first-line screening test for a patient without specific known risk factors for other diseases.
References
* Geschwind, MD. Rapidly progressive dementia. Continuum Lifelong Learning Neurol. 2016;22(2):510-537.

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