MEMORY LOSS (Algorithmic Diagnosis of Symptoms and Signs)
MEMORY LOSS
Ask the Following Questions:
- Is there a history of trauma? A history of trauma would suggest concussion, intracranial hematoma, and posttraumatic epilepsy, among other conditions.
- Is there a history of alcohol or drug ingestion? Chronic alcoholism is associated with Korsakoff's syndrome and Wernicke's encephalopathy. Drugs such as bromides, barbiturates, cocaine, and LSD may induce memory loss. Heavy metals such as lead may cause a chronic encephalopathy with memory loss.
- Are there systemic signs and symptoms? If there is anemia and memory loss, one should consider pernicious anemia. Pellagra, beriberi, myxedema, lupus erythematosus, uremia, and liver failure may be associated with memory loss.
- Are there other focal neurologic signs? Extrapyramidal symptoms may be found in Wilson's disease, Huntington's chorea, and Parkinson's disease. Long tract signs may be found in multiple sclerosis, Creutzfeldt-Jakob disease, general paresis, and normal pressure hydrocephalus. When there is memory loss without focal neurologic signs, Alzheimer's disease and Pick's disease should be considered, as well as malingering.
DIAGNOSTIC WORKUP
It is wise to start with simple tests of mental status such as the Kendrick cognitive tests for the elderly or Mini-Mental State Examination. Routine laboratory tests include a CBC, sedimentation rate, urinalysis, chemistry panel, ANA, serum B
12
and folic acid, and VDRL test. In the elderly, a chest x-ray should be done to look for a primary neoplasm.
If these studies are negative, the patient may be referred to a neurologist, or a CT scan or MRI may be done. The neurology consultation is much less expensive. Ultimately, a spinal tap may need to be done to look for multiple sclerosis and central nervous system lues. A lumbar isotope cisternography may need to be done to rule out normal pressure hydrocephalus. A referral to a psychologist can be made for psychometric testing.
Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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