Neurology Case Challenge: A 42-Year-Old With Memory Loss, Slurred Speech, and Dyspnea

Catherine Divingian, MD, PhD; Beena Stanley, MD; Jeffrey Jordan, MD


March 06, 2023

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 42-year-old woman presents with shortness of breath, which started that afternoon. The onset of dyspnea was at rest, and she has found no relieving factors. She also reports a 3-week history of difficulty with speaking. Her dysarthria is associated with slow and slurred speech. She denies any cognitive deficits, such as word-finding difficulties, or problems with accessing declarative or procedural memory; however, she expresses concerns about worsening short-term memory.

The patient has problems with swallowing, which have progressively worsened over the past 3 weeks. She has dysphagia to both solids and liquids but does not have odynophagia. The patient reports that her symptoms fluctuate throughout the day; by evening, she is unable to eat or drink.

She underwent esophagogastroduodenoscopy a few days before presentation to the emergency department. The results were normal, as were the biopsy samples obtained at that time. On the day she was scheduled for follow-up with a barium swallow study, she experienced sudden-onset shortness of breath and went to the emergency department instead.

Her medical history is notable for hypertension and hyperlipidemia, which are treated with lisinopril and atorvastatin, respectively. She takes both medications as prescribed and reports no adverse effects. She reports no tobacco, alcohol, and illicit drug use. Her family history is unknown because the patient was adopted. She is married, and her two children are in college and are healthy.


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