Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
A 34-year-old Pakistani woman presents with a 4-year history of psychotic behavior and neurocognitive decline. She has been under the care of different psychiatrists and has been treated for schizophrenia for 3 years. For the last 6 months, she has had progressive motor regression, loss of speech, and bowel and bladder incontinence. The patient has been bed-bound during this time as well.
The patient has no history of fever, headache, altered sensorium, seizures, or swallowing difficulty. She also has no history of visual impediment, limb weakness, ataxia, or sensory symptoms. She has 2 daughters, both of whom were born through normal vaginal delivery; the last birth was 5 years ago. She is a nonsmoker and is not taking any medications on a regular basis. Her family history is unremarkable.
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Cite this: Sumaira Nabi, Zakir Jan, Muhammad Irshad. Neurocognitive Decline and Motor Regression in a 34-Year-Old Woman - Medscape - May 28, 2015.