Here - American Geriatrics Society

P OSTER
A BSTRACTS
In this case it was thought that mediastinal mass is due to SCLC
with metastasis to pancreas, and that he does not have a primary pancreatic
cancer with metastasis to mediastinum or that he did not have
two primary cancers.
Conclusion: This case is un-usual as it is rare for lung cancer to
have metastasis to pancreas and it is also rare for primary pancreatic
cancer to be small cell.
C5
An Unusual Approach to Aggressive Behavior in Dementia
Patients.
A. I. Akintan, 1 V. Nurpeisov, 1 B. Patel, 2 N. Holland. 2 1. Geriatric medicine,
Emory University, Atlanta, GA; 2. Geriatric medicine, VA
Medical Center, Decatur, GA.
We recently saw an 85 year old gentleman in the geriatric clinic
with a past medical history of hypertension, osteoarthritis and dementia.
He has had Alzheimer’s dementia for the past four years with
increasing episodes of agitation. He was on the following medications;
Aspirin, Metoprolol, Donepezil, Memantine, Allopurinol,
Cyanocobalamin, Lisinopril, Furosemide and Acetaminophen.
In an attempt to decrease his polypharmacy his Allopurinol was
weaned off as he had no history of gout for the past five years. His aggressive
behavior increased shortly after stopping the Allopurinol
and this was subsequently restarted at the family’s request. His aggressive
behavior stabilized after restarting Allopurinol.
A review of the literature looking at Allopurinol in the treatment
of aggression in dementia revealed two case reports.
Allopurinol, a xanthine oxidase inhibitor decreases production
of oxygen free radicals and promotes accumulation of purines and
thus increases circulating pools of adenosine that may ultimately
have antipsychotic and anxiolytics effects.
We present this case as we feel that the possible association of
using Allopurinol in treatment of aggressive behavior in patients with
dementia is not well known.
This may offer an alternative therapy for aggressive behavior in
dementia patients who also have recurring gouty arthritis and may
prove useful with more studies in other patients with dementia and
aggressive behavior.
C6
Infection Associated Parasthesia: Case of “parasthesias gone wrong”
A. Itticheria, B. Setters, R. Gopalraj. Family & Geriatric Medicine,
University of Louisville, Louisville, KY.
Introduction: Parasthesia is a main symptom of stroke, TIA’s,
and other neurological conditions. Other underlying etiologies including
the possibility of an infectious process should also be considered.
Symptoms such as generalized or unilateral weakness, numbness
and tingling of the extremities and sensory deficits have been
seen in patients with acute infections.
Case Report: A 64 yo female with history of a right middle cerebral
artery stroke presented with acute left handed weakness that was
gradually worsening. This was associated with asthenia and dysuria.
Review of systems found stumbling and falls. Physical exam revealed
mild left sided facial droop, decreased sensation of the left side, including
face, arm and leg. Strengths were 5/5 and reflexes were 2+ bilaterally.
She was dehydrated, with mild renal insufficiency and hypotension.
A CT of the head was negative for any acute changes and
brain MRI was unchanged showing a previous full occlusion of right
cervical and intracranial internal carotid artery. EEG was also negative.
A diagnosis of urosepsis was made and the patient was started on
IV antibiotics and aggressive IVF hydration. With appropriate treatment
in the next few days her symptoms fully resolved and the patient
was discharged home.
Three months later, she presented to the office with generalized
weakness, tingling sensation in the fingertips of the right hand with
numbness, blurred vision of the right eye, and sinusitis like symptoms.
Again, her vital signs and exam were unremarkable, but given her history
she was admitted to the hospital for further evaluation where
MRI/A of the head showed no changes. She was diagnosed with acute
sinusitis and treated with oral antibiotics. Her symptoms immediately
improved and had resolved by the next day when she was discharged
home at her baseline functional status. On both hospital visits the
neurology consultant was not able to link any symptoms to a neurologic
diagnosis.
Conclusion: This case illustrates that paresthesias may not always
be due to the typical neurological etiologies. As such other
causes including infection must be considered and a comprehensive
history and exam must be completed. Infectious processes may mimic
such symptoms due to associated sepsis, fever, or dehydration.
Recognition and treatment of potential infections might be the unusual
but simple answer to a startling presentation of new onset
paresthesias.
C7
Case Report of a Purple Rash and Gum Pain.
A. Lum. Geriatric Medicine, University of Pittsburgh Medical Center,
Pittsburgh, PA.
Case Report
Lum, Albert. University of Pittsburgh Medical Center Geriatric
Fellow. Pittsburgh, PA
A 68 years old Caucasian female with complaints of burning
pain to her oral mucosa and gums off and on for 4 months seen at
an outpatient clinic. She described the pain as burning type especially
after eating hot spicy foods and worsened in the morning
when she brushes her teeth. She also noticed purple pruritic rash to
her hands started approximately same time as her gums. She had no
previous history of similar symptoms. Her past medical history include
GERD and borderline hypertension. She denies smoking, illicit
drugs and alcohol use. She lives alone and is not sexually active.
She is currently taking omeprazole 20mg daily for GERD and
started on lisinopril 5mg daily approximately 5 months ago.On
physical exam her vital signs were normal. Oral exam her buccal
mucosa and gums had shallow, tender, erythematous small erosions