|Contributed by Edward C. Klatt, MD|
|Department of Pathology, University of Utah School of Medicine|
CASE 1: A 65 year old female had gradual onset of memory problems over three years. She was given a diagnosis of Alzheimer's disease. However, in the past six months her condition had markedly deteriorated with increasing confusion, disorientation, incontinence, mood changes, and inability to carry out activities of daily living. She was then placed in a nursing home. Her condition deteriorated four months later, when her speech pattern was described as "word salad". Six months later she became nonambulatory and noncommunicative. She died shortly after.
CASE 2: A 69 year old male was in excellent health until he noted that his walking became unsteady. He had difficulty with his golf swing. His mental sharpness diminished, and friends noted that he talked in an odd fashion. He rapidly deteriorated over the next several months. His gait became more unsteady. He was disoriented, and he became unable to handle financial matters. Seven months after his initial difficulties, he was demented and didn't know who he was. He became agitated and startled easily. He became incontinent of urine and stool. A month later he was confined to a wheelchair, and he was unable to feed himself. He died a year following his initial presentation.
CASE 3: A 61 year old male presented to hospital complaining that he had not been able to walk or think clearly that day. A cerebral angiogram suggested small vessel vasculitis. A magnetic resonance imaging (MRI) scan showed only white matter changes consisting of multiple foci of T2 weighted hyperintensity measuring less than one cm. An electroencephalogram showed some periodic discharges with diffuse slowing. He continued to have progressive deterioration in cognition along with ataxia, personality changes, and dysarthria, as well as hyperreflexia. Following results of a brain biopsy, he was discharged home, where he died only six weeks following his initial presentation.
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