A 78-year-old man presented to his GP with an unsteady gait. He had noticed progressive gait deterioration over several months and had had several falls. His wife had commented that there had been deterioration in concentration and immediate memory. He had become irritable and careless and appeared less emotional. He was initially diagnosed with depression and his GP commenced him on citalopram, which had little effect. He had a past medical history of benign prostatic hypertrophy and hypertension treated with bendroflumethiazide. On examination he was thin. He appeared easily distractable and there was marked perseveration. He scored 21/30 on mini-mental state examination with deficiencies in executive function and naming. There were bilateral palmomental reflexes, but cranial nerve and upper limb examination appeared intact. Lower limb examination revealed a gait apraxia. Cardiovascular, respiratory and abdominal examinations were all normal . It was noted that he had been incontinent of urine. A lumbar puncture was performed and yielded the following data:Opening pressure 19 cmH2O - CSF protein 0.45 g/L (0.15-0.45) CSF white cell count 4 cells per ml (
Posted on: Fri, 28 Nov 2014 13:13:50 +0000
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