A 65-Year-Old Woman With Decreased Coordination

Caroline Tschibelu, MD

Disclosures

January 27, 2016

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.

Background

A 65-year-old woman presents to the emergency department (ED) with several days of increasing confusion and decreased coordination. The symptoms started insidiously over the past 2 months, as the patient experienced some confusion and became increasingly forgetful. Over the past week, she has become more off-balance and has had difficulty with purposeful movements.

The patient's husband pressed her to come to the ED because she walked into a wall in her house that afternoon and again in the evening. She is a homemaker and has lived in that house for 15 years with her husband. She usually walks without assistance and does not report additional neurologic symptoms. She reports recent weight loss.

The patient reports having had a chronic dry cough for months, for which she recently started taking an over-the-counter cough syrup. She denies hemoptysis, night sweats, or fever. Otherwise, she has no known medical history, because she has not seen a doctor regularly in 23 years. She smoked one pack of cigarettes per day for 30 years but stopped when she started coughing. She does not use drugs or drink alcohol and has no allergies or family history of significant illness.

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