Medical Challenge | Altered Mental Status

Posted on October 23, 2011


This week’s Medical Challenge is from guest blogger Vincenzo Happach – medical student at DMU & good personal friend of mine.  If you would like to submit a guest post or a medical case of your own, please use the contact page.

An 86 year old Caucasian female presents to the medicine floor after, while driving, she began to feel anxious, confused, and lost.

She pulled over and called 911 to take her to the hospital.

Upon examination the next morning the patient is oriented only to person.  She knows she’s in the hospital but is not sure which one.  Exam is notable only for bilateral peripheral neuropathy of the lower extremities.  Gait is normal, strength is 5/5 & reflexes are 2+ in all extremities.

She has a past medical history of Anxiety, Hypothyroidism, and Diabetes Mellitus Type II.  She admits to occasional incontinence of urine when startled or during bouts of laughter.

Her medications include Synthroid, Metformin, Aspirin, Lisinopril, Cymbalta and Glipizide.

On the Veteran’s Association SLUMS mini mental exam she scored a 21/30 (normal >25) and her clock drawing test results are shown below.

For the clock drawing test the patient was given a piece of paper with a pre-drawn circle and asked to fill in the numbers and set the hands to read 11 o’ clock.  This is what was drawn:










From the above information alone and using the results of the MME and CDT. What is the most likely underlying cause of the patient’s mental status?

A)  Diffuse Lewy Body dementia
B)  Alzheimer’s dementia
C)  Normal Pressure Hydrocephalous
D)  Acute Medication Delirium
E)  Left sided lacunar stroke

Leave your answer below and check back in 48 hours for the explanation.

Posted in: Medicine