Clinical reasoning: progressive visuospatial problems in a 71-year-old man

Neurology. 2014 Jul 1;83(1):e6-10. doi: 10.1212/WNL.0000000000000548.

Abstract

A 71-year-old right-handed man presented with a 3-month history of progressive cognitive impairment. Six weeks before presentation, he became unable to use his mobile phone, with difficulties pressing the digits in the correct order. He had developed problems reading, describing a jumbled-up appearance of words on the page. He omitted single letters when writing, and had difficulty in using cutlery and accurately judging portion sizes. He had ceased driving due to navigational problems and because of repeatedly hitting the curb. In the last 4 weeks, he had developed difficulty dressing. Notably, he had good insight, being able to give a detailed description of symptoms.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Blood Sedimentation
  • Brain / pathology
  • C-Reactive Protein / metabolism
  • Enzyme Inhibitors / therapeutic use
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Methotrexate / therapeutic use
  • Perceptual Disorders / diagnosis*
  • Perceptual Disorders / drug therapy
  • Perceptual Disorders / physiopathology*
  • Photic Stimulation
  • Space Perception / drug effects
  • Space Perception / physiology*

Substances

  • Enzyme Inhibitors
  • C-Reactive Protein
  • Methotrexate