Clinical Reasoning: A 66-Year-Old Woman With Progressive Encephalopathy and Bilateral Hearing Loss

Abstract

Section 1A 66-year-old woman with no medical history presented to an outside hospital for an acute alteration in cognition described as wandering aimlessly, combative behavior and incomprehensible speech that progressed over three days. Upon arrival she had altered cognition, psychomotor agitation and inability to follow commands, but no weakness, dysarthria, sensation loss, vision loss or meningismus. Vital signs and laboratory studies including complete blood count, comprehensive metabolic panel, urinalysis, and urine drug screen were normal. Questions for Consideration:1. What is the localization for her presentation? 2. What is the initial differential diagnosis? 3. What studies should be conducted? Section 2