Rapidly reversible dementia

Abstract

In April, 2000, 69-year-old man was evaluated because he had had progressive cognitive dysfunction for a year. He had been a business executive before to the onset of his symptoms. He had a long history of migraine with aura; his headache was unilateral, but alternating. One year before we saw him, he developed pulsatile tinnitus in his right ear. Over the next few months, he became unable to carry on his business. Six months after the onset of his illness, he had many three-hour-long episodes of blurred vision, slurred speech, and left hemiparesis. At that time, computed tomography (without contrast) of his head, transthoracic echocardiogram, electrocardiogram, carotid ultrasound, serum cholesterol, and haemoglobin A1C were normal. He had been treated empirically with clopidogrel, then warfarin, by his referring physician. In the month before evaluation, he had slept most of the day; when awake he was unable to turn on his computer, use the telephone, or recall his telephone number. We found no abnormalities on physical examination. There were no carotid, ocular, nor mastoid bruits. He had profound psychomotor slowing, and was markedly inattentive. He was unable to comply with detailed memory testing. There was no aphasia, apraxia, or neglect.