Clinical Reasoning: Rapid progression of reversible cognitive impairment in an 80-year-old man.

Abstract

An 80-year-old right-handed man was accompanied by his wife to the neurology clinic for difficulties in performing activities of daily living. He was reported to struggle using cutlery and remembering how to dial a phone number. His wife had noticed changes in his speech, which had become incomprehensible. Symptom onset was insidious, with progressive worsening over a couple of weeks. The patient himself had no complaint. His medical history included an episode of transient vertical diplopia 2 months prior to admission, diagnosed as a TIA in the midbrain. Brain MRI at the time of TIA showed no acute lesion but moderate vascular white matter disease (WMD), related to arterial hypertension and type II diabetes, and 11 lobar microbleeds (bilateral temporal, parietal, and frontal).