{"title":"Clinical Reasoning: A 68-Year-Old Man With Progressive Numbness, Vertigo, and Cognitive Decline.","authors":"Stephanie Marie Regan, Long F Davalos","doi":"10.1212/WNL.0000000000213437","DOIUrl":null,"url":null,"abstract":"<p><p>A 68-year-old man presented with subacute progressive numbness in his lower extremities and vertigo. Concurrently, he developed behavioral and cognitive changes. Initial examination demonstrated mild distal symmetric weakness in the lower extremities, allodynia in the feet, decreased proprioception at the ankles, and absent reflexes in the lower extremities. Electrodiagnostic studies showed a length-dependent, severe axonal sensorimotor polyneuropathy. He was hospitalized after experiencing daily falls and worsening executive dysfunction, during which time additional cognitive history and examination were completed. MRI brain revealed diffusion restriction in the bilateral caudate nuclei. Ultimately, CSF testing solidified the clinical diagnosis. This case highlights the differential diagnosis and diagnostic approach for rapidly progressive neuropathies associated with cognitive decline.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 5","pages":"e213437"},"PeriodicalIF":7.7000,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1212/WNL.0000000000213437","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/6 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
A 68-year-old man presented with subacute progressive numbness in his lower extremities and vertigo. Concurrently, he developed behavioral and cognitive changes. Initial examination demonstrated mild distal symmetric weakness in the lower extremities, allodynia in the feet, decreased proprioception at the ankles, and absent reflexes in the lower extremities. Electrodiagnostic studies showed a length-dependent, severe axonal sensorimotor polyneuropathy. He was hospitalized after experiencing daily falls and worsening executive dysfunction, during which time additional cognitive history and examination were completed. MRI brain revealed diffusion restriction in the bilateral caudate nuclei. Ultimately, CSF testing solidified the clinical diagnosis. This case highlights the differential diagnosis and diagnostic approach for rapidly progressive neuropathies associated with cognitive decline.
期刊介绍：
Neurology, the official journal of the American Academy of Neurology, aspires to be the premier peer-reviewed journal for clinical neurology research. Its mission is to publish exceptional peer-reviewed original research articles, editorials, and reviews to improve patient care, education, clinical research, and professionalism in neurology.
As the leading clinical neurology journal worldwide, Neurology targets physicians specializing in nervous system diseases and conditions. It aims to advance the field by presenting new basic and clinical research that influences neurological practice. The journal is a leading source of cutting-edge, peer-reviewed information for the neurology community worldwide. Editorial content includes Research, Clinical/Scientific Notes, Views, Historical Neurology, NeuroImages, Humanities, Letters, and position papers from the American Academy of Neurology. The online version is considered the definitive version, encompassing all available content.
Neurology is indexed in prestigious databases such as MEDLINE/PubMed, Embase, Scopus, Biological Abstracts®, PsycINFO®, Current Contents®, Web of Science®, CrossRef, and Google Scholar.
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