Progressive memory loss mid 20s male

[CountryMed]

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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[BurghStudent]

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.

 

[FlameBroiledDoc]

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

 

[Anicetus]

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?

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

 

[chizledfrmstone]

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

 

[Psai]

tsh b12 syphilis sleep study

 

[Crayola227]

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

the history guides my work up a bit too

this is confusing

 

[Phloston]

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?

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).

 

[siliso]

Sleep onset latency study and treatment as indicated for results - modafinil, methylphenidate, xyrem qhs as prescribed by sleep specialist. Neuropsych eval to quantify cognitive/memory impairment

 

[wegh]

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?

MRI? lumbar puncture? What...

Lab work, sure. Sleep study, definitely. Then a trip to the psychologist to see if the patient has anxiety or adhd which can cause memory dysfunction. Sounds like OP has a little bit of anxiety just from the post haha