Pls help me figure this out

[Madhatter]

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hi! could someone be so kind as to help me out with a difficult case. a 53 yo woman has a lack of interest in things, lack of patience, strong anger fits, bitterness, complains of freezing feeling traveling up from the base of her neck upwards in her brain, and also forgets roads that she travels on frequently. what could this be?? 😕

 

[syrinx]

hi! could someone be so kind as to help me out with a difficult case. a 53 yo woman has a lack of interest in things, lack of patience, strong anger fits, bitterness, complains of freezing feeling traveling up from the base of her neck upwards in her brain, and also forgets roads that she travels on frequently. what could this be?? 😕

What does she show on exam? Memory, language, frontal lobe functions...?

 

[BrainSight]

hi! could someone be so kind as to help me out with a difficult case. a 53 yo woman has a lack of interest in things, lack of patience, strong anger fits, bitterness, complains of freezing feeling traveling up from the base of her neck upwards in her brain, and also forgets roads that she travels on frequently. what could this be?? 😕

Depression?
Fronto-temporal dementia? (although even with MMSE of <20, FTD seldom gets lost)

Of course you can easily rule out both with your history/neuro exams...

 

[Head]

hi! could someone be so kind as to help me out with a difficult case. a 53 yo woman has a lack of interest in things, lack of patience, strong anger fits, bitterness, complains of freezing feeling traveling up from the base of her neck upwards in her brain, and also forgets roads that she travels on frequently. what could this be?? 😕

I'm guessing you're a 3rd year med student on your neuro rotation hoping someone else will do your homework for you? If not sorry for the sarcasm.

Keep in mind that I'm only a 4th year student, but based on the limited amount of info you've given us it sounds the most like depression. Here are the classic depressive symptoms: depressed mood for extended period of time, anhedonia (lack of interest in things you used to enjoy), social withdrawal, little tolerance of frustration, weight gain or loss, fatigueability, early morning awakening, insomnia or hypersomnia.

The freezing sensation shooting up her neck could be some kind of somatization disorder (the mind creating unusual sensations that don't fit normal physiologic pathology) secondary to her depression. It could also represent some sort of c-spine disease compressing nerves. Impossible to tell without a better history and physical.

The forgetfulness could also be secondary to depression (lack of ability to concentrate and maintain attention is another symptom) or be an early sign of one of the dementias as stated by another poster. Again hard to determine without a better hx and physical.

 

[syrinx]

Major depressive disorder is a thought but should really be a diagnosis of exclusion. Frontotemporal dementia is a good thought given the right clincal history and exam given her relatively young age and even better if positive family hx (tau mutation chromosome 17). Pseudodementia is a good possibility. I'd also rule out things like hypothyroidism and infectious etiologies.

 

[scared sh*tless]

hi! could someone be so kind as to help me out with a difficult case. a 53 yo woman has a lack of interest in things, lack of patience, strong anger fits, bitterness, complains of freezing feeling traveling up from the base of her neck upwards in her brain, and also forgets roads that she travels on frequently. what could this be?? 😕

Yeah in agreement with others I would need to know more to narrow down this wide differential:

specifically:
medical hx?
Psych hx?
metabolic/ electrolyte/ vitamins?
What does the neuro exam show?
What is the time course?

I mean, it's actually a good exercise to think about what else you would need to ask to narrow it down. I bet we will get real consults like this as neurologists!

 

[Madhatter]

i found out that she does have hypothyroid, but is on medication for that. but what effect could hypothyroid have on the symptoms i listed in the original post??

 

[syrinx]

i found out that she does have hypothyroid, but is on medication for that. but what effect could hypothyroid have on the symptoms i listed in the original post??

Hypothyroidism can give you depression, dementia, mental dullness, polyneuropathy and is a common cause of these symptoms. Just because she is on meds doesn't rule this out. Check TFTs to make sure she is being compliant and on therapeutic doses.

 

[syrinx]

BTW, do you have a better history and exam yet?