A 50-year-old lady presented with a one-month history of fatigue and depression. She had lost her appetite and had noticed some weight loss. She complained that the shape of objects appeared distorted and out of alignment. On examination she appeared depressed, but examination was otherwise normal. Full blood count, electrolytes, calcium, phosphate, thyroid function and immunoglobulins were all normal. Syphilis and HIV serology were negative. She was commenced on fluoxetine.On review one month later, she was brought into the clinic with the assistance of her husband. She claimed to be unable to see and needed guiding to her chair. Her husband reported that she was extremely apathetic and generally unable to perform any of her normal daily tasks. On examination she sat silently, displaying little spontaneous activity except for occasional jerking of her limbs. However, she did exhibit a marked startle response to an unexpected hand-clap. Attempts at higher mental function testing were limited to three- and four-word responses, most of which were inappropriate. She said she could not see any of the picture boards. However, fundoscopy and pupillary reactions were normal. The remainder of the cranial nerve examination was normal. Limb power seemed intact, with normal reflexes but bilateral up-going plantars. General examination was normal. CT was normal. CSF: no cells, protein 0.4 g/l, no oligoclonal bands. What is the most likely diagnosis? a) Variant Creutzfeldt–Jakob disease (vCJD) b) Creutzfeldt–Jakob disease (CJD) c) Fluoxetine side effect d) Huntington’s chorea e) Lithium intoxication
Posted on: Sun, 01 Sep 2013 10:42:07 +0000
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