Book contents
- Common Pitfalls in Cognitive and Behavioral Neurology
- Common Pitfalls in Cognitive and Behavioral Neurology
- Copyright page
- Dedication
- Contents
- Diseases Discussed in the Book
- Preface
- Acknowledgements
- Abbreviations
- Part 1 Missing the Diagnosis Altogether
- Part 2 Misidentifying the Impaired Cognitive Domain
- Part 3 Missing Important Clues in the History
- Part 4 Failure of Pattern Recognition
- Part 5 Difficult-to-Characterize Cognitive/Behavioral Disorders
- Part 6 Clinical Findings That Are Subtle
- Part 7 Misinterpreting Test Results
- Part 8 Attributing Findings to a Known or Suspected Disorder
- Part 9 Missing Radiographic Clues
- Part 10 Management Misadventures
- Case 46 I Don’t Know When to Stop
- Case 47 Is It Still Helping?
- Case 48 Caring for the Caregiver
- Case 49 Better Safe than Sorry?
- Case 50 Great Expectations
- Case 51 Nothing Can Be Done
- Index
- Plate Section (PDF Only)
- References
Case 50 - Great Expectations
from Part 10 - Management Misadventures
Published online by Cambridge University Press: 03 November 2020
- Common Pitfalls in Cognitive and Behavioral Neurology
- Common Pitfalls in Cognitive and Behavioral Neurology
- Copyright page
- Dedication
- Contents
- Diseases Discussed in the Book
- Preface
- Acknowledgements
- Abbreviations
- Part 1 Missing the Diagnosis Altogether
- Part 2 Misidentifying the Impaired Cognitive Domain
- Part 3 Missing Important Clues in the History
- Part 4 Failure of Pattern Recognition
- Part 5 Difficult-to-Characterize Cognitive/Behavioral Disorders
- Part 6 Clinical Findings That Are Subtle
- Part 7 Misinterpreting Test Results
- Part 8 Attributing Findings to a Known or Suspected Disorder
- Part 9 Missing Radiographic Clues
- Part 10 Management Misadventures
- Case 46 I Don’t Know When to Stop
- Case 47 Is It Still Helping?
- Case 48 Caring for the Caregiver
- Case 49 Better Safe than Sorry?
- Case 50 Great Expectations
- Case 51 Nothing Can Be Done
- Index
- Plate Section (PDF Only)
- References
Summary
This 77-year-old right-handed man presented to the clinic with a 15-year history of slowly progressive fatigue associated with cognitive difficulties. He reported being slow in his thinking, with difficulties concentrating and multitasking. In the past seven years, his gait slowed, balance declined, and he walked more cautiously to avoid falls. In addition, he developed urinary urgency with occasional incontinence. His neurological exam revealed bradykinesia, cogwheel rigidity and resting tremor, most prominent in the right arm. His gait was mildly wide based, slow with decreased arm swing, and he had stooped posture. On neuropsychological evaluation he was slow in his cognitive processing but, when given additional time, he performed within normal limits in all cognitive domains, including executive function. His brain MRI revealed ventriculomegaly with subcortical and periventricular white matter hyperintensities. The degree of ventriculomegaly was considered disproportionate to the degree of parenchymal atrophy (Figure 50.1). These findings led to the suspicion of normal pressure hydrocephalus (NPH).
- Type
- Chapter
- Information
- Common Pitfalls in Cognitive and Behavioral NeurologyA Case-Based Approach, pp. 161 - 163Publisher: Cambridge University PressPrint publication year: 2020