Progressive memory loss mid 20s male

Discussion in 'Clinical Rotations' started by CountryMed, Feb 14, 2017.

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  1. CountryMed

    CountryMed

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    26 yo M with progressive memory loss over past 3 years. No mood, executive functioning, long term memory changed and motor function is intact. No alcohol abuse or depression. Only other medical problem is narcolepsy that began around the same time. Physical exam unremarkable.

    What you do for next workup.

    Labs
    MRI head
    Lumbar puncture

    Whats next?
     
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  3. BurghStudent

    BurghStudent lurker 7+ Year Member

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    Administer a MOCA to further characterize his memory loss.

    Ask about sleeping patterns to determine if it's secondary to narcolepsy.

    Substance abuse. Medication side effect.
     
    Last edited: Feb 14, 2017
  4. FlameBroiledDoc

    FlameBroiledDoc

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    Get a more detailed history with collateral information, in particular before ordering an LP.
     
  5. Anicetus

    Anicetus 2+ Year Member

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    You're not having memory loss. It's called 3rd year. Welcome to the club.
     
  6. chizledfrmstone

    chizledfrmstone MSIII SDN Moderator 7+ Year Member

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    Op, you're not asking for medical advice are you?
     
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  7. Psai

    Psai Account on Hold 2+ Year Member

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    tsh b12 syphilis sleep study
     
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  8. Crayola227

    Crayola227 Death Trooper Boot Licker 2+ Year Member

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    were we supposed to list all the labs in the workup?

    the history guides my work up a bit too

    this is confusing
     
  9. Phloston

    Phloston Lifetime Donor 5+ Year Member

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    Narcolepsy is in and of itself associated with amnesic symptomatology. If that was previously diagnosed, then the presentation isn't unusual. Yes, we would want to do an MMSE and gather additional Hx (eg, is he on meds; what are his exposures [work/home]; does he use drugs; is the amnesia subjective and/or objective). I would say an MRI would be ridiculous to order in this context without more simple imaging first (eg CT), but wouldn't order that unless for good reason (and what value would that add; what are you actually looking for; does he have focal signs, confusion interfering with a neuro exam, papilledema, seizures, morning vomiting, etc.) If he does have any of the latter, you'd have to do a CT before an LP because of the risk of mass lesion. But all of that would come after bloods anyway. FBC, TSH, B9/12, lead level, and toxicology screen are a must. Also think other risk factors and laterally (eg HSV, neurosyphilis, neuro Lyme, SSPE, etc...CO poisoning...broad DDx; pending Hx/exam).
     

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