Neuro-oph Case 5: Introduction

History of Present Illness (HPI)

A 45 year old man with generalized anxiety disorder presents to your office for concerns of memory loss. He states that over the past few months, he had been having trouble keeping up at his job in accounting and was laid off last week. He is accompanied by his wife, who says that he has been inattentive, forgetful, and often confused lately. She first started to notice this about three months ago but it has progressively worsened to the point where he now often “seems out of it,” and needs assistance with some IADLs, such as managing their bills and helping with house chores. He is still independent in ADLs. He mentions that he’s felt overly tired and experienced intermittent headaches over the past month, but attributes this to stress from his former job.

He saw an ophthalmologist last week because he’s had some difficulty reading. He  thought he needed glasses but he was advised to see a neurologist given changes found on his visual field test. He denies aphasia, changes in hearing, dysphagia, dizziness, pain, weakness, changes in sensation. He takes escitalopram for his anxiety, and has not had medication or dosage changes in over a year. He sees a psychiatrist monthly who also recommended he make an appointment with a neurologist due to the recent memory changes.

Medical history: Generalized anxiety disorder. Denies history of HTN, hyperlipidemia, diabetes mellitus.  
Medications: escitalopram 
Allergies: no known allergies
Family history: non-contributory 
Social history: Lives with his wife in NYC. Drinks a glass of wine 5-6 times per week. Reports he occasionally smokes marijuana 3-4 times per year. Denies cigarette smoking. Sexually active with his wife, has not had STI testing in over 15 years.

What’s on your differential diagnosis? Choose at least 3 before moving on!
Early onset Alzheimer’s dementia
Creutzfeldt-Jakob disease
HSV encephalitis
PCA infarct
Acoustic neuroma
Vascular dementia
MCA stroke
Vitamin B12 deficiency
Vertebrobasilar insufficiency

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