A Neuro Dilemma from Dr. Shafer

by Bob Stuntz

Welcome back Dr. Krystle Shafer, who has the following conundrum for us:

A 57 y/o male presents to the ED with a chief complaint of sudden loss of memory. His wife reports that when he awoke this morning he was his normal self, had coffee and ate breakfast but while his wife was showering he suddenly told her that he felt “weird”. His wife realized that he had forgotten everything that had happened not only this morning but also the night prior and was very tearful and frightened which is unlike his normal personality.  Last night he drank four beers which he usually does every weekend. His wife denies any trauma, or LOC, slurred speech or weakness. His only medical problem is hypertension. He has no significant family history, does not smoke and denies any illicit drug use. On physical examination, initially on arrival to the department he was only oriented to self but after an hour on he began to remember events from the night prior and became oriented to time and place. He was noted to persistently have trouble making new memories as he scored 0/3 when asked to recall three objects and was also noted to occasionally ask the same questions multiple times.  He can easily remember past events such as his first car and his birthday. Cranial nerves are intact, he has normal sensory and muscle strength in all four extremities bilaterally, normal finger to nose testing and also has a normal gait. The rest of the physical exam is unremarkable

1) At this time, what testing should be performed?

2) What is your diagnosis?

3) What is the prognosis for this diagnosis?