Depressed Mentation in a 52-Year-Old Woman

Mithula Rao Gopalam, MD, MBBS; Moiz Kasubhai, MD, MRCP


January 12, 2018

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 you would like to suggest for a future Case Challenge, please contact us.


A 52-year-old woman with a history of right-sided inflammatory breast cancer presents to the oncology clinic complaining of a 5-day history of headaches and lethargy. She is accompanied by a family member. The patient appears sleepy and is a poor historian, but the family member states that the patient developed a throbbing headache 5 days before presentation; and since the development of her headache, the patient has become increasingly sleepy. Today, she had difficulty awakening.

Initially, the intensity of the headache was high in the mornings and lessened when the patient sat upright; however, the headache has become constant over the past day. The patient also complains of nausea, but she has not vomited and has not had any abdominal pain. The family member thinks the patient is having difficulty walking and notes that the patient has stumbled several times. The patient also complained of blurry vision earlier today. The family member notes that the patient appears confused. The patient states that her head hurts, but she cannot provide further information.

The patient's medical history is significant for right-sided inflammatory breast cancer stage 3 (based on the TNM staging criteria, which in this case was T4d, N2a, M0). She underwent a right modified radical mastectomy 1 year ago, and she completed six cycles of chemotherapy with doxorubicin and cyclophosphamide at that time. Tamoxifen is the only medication she is currently taking, and she has no known allergies.


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