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 72-year-old man has had personality changes for approximately 3 weeks, according to his adult son. The patient's wife and son have accompanied him to the office visit. His son made the appointment because he is concerned that his father has been confused during recent phone calls and occasionally slurs his speech. The son also says that his father seems to be more sleepy than usual and has been irritable for the past few weeks. He speaks with his parents several times a week and notes that his father had not previously exhibited any symptoms of dementia, such as forgetfulness, lack of awareness, confusion, or inability to take care of himself.
The patient and his wife have not noticed any of the symptoms that their son has described. Both of them say that he has not had any weakness of the extremities or face, sensory changes, or coordination deficits.
The patient's only complaint is that he has had difficulty chewing for the past several months. He does not want to see a dentist because he says that "they always do a lot of unnecessary things and charge a lot of money."
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Cite this: Heidi Moawad. A Man With Hypertension and Recent Personality Changes - Medscape - Oct 30, 2023.