Here - American Geriatrics Society

P OSTER
A BSTRACTS
most physicians’ differential diagnosis when working up cognitive
disorders even in younger patients. Given that the presenting symptoms
may be vague and individually common with a routine evaluation
that is usually non-diagnostic, the clinical and family history can
be crucial in making the diagnosis. To establish the diagnosis a
NOTCH3 mutation by genetic analysis or a skin biopsy showing ultra
structural deposits within small blood vessels is needed.
A25
Space Occupying Lesions of the Brain Presenting with
Neuropsychiatric Symptoms.
T. Beben, M. F. Assal, D. D. Sewell, J. Reichstadt, J. W. Daly. UC San
Diego, San Diego, CA.
Supported By: No funders provided support for this research.
Introduction: Cognitive and behavioral problems are often attributable
to underlying degenerative or psychiatric processes. Here
we present two atypical cases.
Case 1: An 86-year-old man with a history of CAD and TIAs developed
memory and executive function deficits three years prior to
his presentation at our institution. Brain imaging and labs were normal
and he was eventually diagnosed with frontotemporal dementia.
Five months prior, his decline accelerated prompting placement in a
residential care facility. He was noted to have acutely worsening behavioral
symptoms, including wandering, disorganization, agitation,
and impulsivity leading to falls, which led to his admission to our behavioral
unit. Basic labs were normal. A head CT, ordered due to a recent
fall, unexpectedly demonstrated a large mass. Subsequent MRI
delineated a 7x4cm right temporal lobe mass with ring enhancement
and central necrosis, most consistent with glioblastoma multiforme,
which was felt to account for his accelerated decline. The patient was
treated symptomatically with divalproex, olanzapine, and dexamethasone.
After a family meeting, he was referred to hospice.
Case 2: A 60-year-old woman with a history of hypertension and
depression was brought to our geriatric assessment clinic by her
daughter to investigate the cause of her personality changes and decline
in executive function. She had worked as a lab technician until
six years prior, when she became unable to perform work on time or
learn new tasks. She had since been unemployed and could not manage
her finances. At times, she was withdrawn in her cluttered apartment
and neglected her personal hygiene. She also showed poor impulse
control and judgment through inappropriate actions with
strangers and debt accrual. Our initial evaluation revealed a score of
28/30 on the MoCA, but difficulty with attention. A routine brain
MRI was obtained, revealing a 7.2 cm extraaxial right frontal lobe
mass. She was admitted to neurosurgery. Upon successful resection of
the mass, a diagnosis of meningioma was confirmed. After a post-operative
course that was complicated by hydrocephalus requiring a VP
shut, her former personality began to re-emerge.
Conclusions: Brain masses should not be overlooked as a potential
cause of neuropsychiatric symptoms. An accurate diagnosis can
help define prognosis and may guide treatment options.
A26
Clinical significance of measuring Blood Pressures in bilateral arms
in patients with dizziness.
T. Gyurmey, P. Coll, K. Singh. Geriatrics, University of Connecticut
Health Center, Farmington, CT.
82 y/o lady with DM type 2, CAD, HTN, TIA, lumbar stenosis,
anemia of chronic disease, depression, GERD and PVD presents
with left arm easy fatigability and episodic dizziness for 1 year. She
was evaluated for dizziness and medications were reviewed with discontinuation
of betablockers and the left arm fatigue was presumed
by the patient to be as a result of the left shoulder replacement.She
was symptom free for a few months until they returned. Past surgical
history is significant for left shoulder joint replacement and left
carotid artery stenting. Medications include morphine, bupropion,
pravastatin, amlodipine, alendronate, epoetin alfa injections and lorazepam
prn.She is afebrile, BP Rt arm 142/48, BP Lt arm 102/40, PR
88 regular with diminished left radial artery pulsations, RR 12, orhtostatics
negative. EOMI, exams of the HEENT, lungs, heart, abdomen
and CNS were unremarkable. No peripheral edema. B/L Lower limb
pulses are equal and symmetric. Based on the difference in systolic
blood pressures and the symptoms, a presumptive diagnosis of Subclavian
artery stenosis with steal syndrome was made.
Management included prompt percutaneous transluminal angiography
followed by angioplasty involving tandem stents being
placed at two proximal left subclavian stenosed sites before the origin
of the vertebral artery without any complications. She was on clopidogrel
for a month and currently takes aspirin 325 mg daily and is
symptom free.
Discussion: Dizziness is a very common symptom in the elderly
and can lead to decreased quality of life and predispose to falls and
subsequent morbidity and mortality.Blood pressures, pulse rates and
orthostatics are routinely measured but not often in both arms which
could lead to missing the diagnosis of subclavian stenosis and steal
syndrome that this patient presented with. On the other hand a
falsely normal blood pressure reading in the arm affected by a stenosis
could delay a diagnosis of Hypertension and subsequently lead to
avoidable and sometimes devastating short term complications and
long term end organ damages. Measuring blood pressure and pulses
in both arms is a very simple but invaluable step that should be done
routinely.
A27
Closed head injury with multisensory loss in a 74 year old athlete
while playing senior league basketball.
U. Kakwan, 1 N. Miller, 3 U. Braun. 2,1 1. Geriatrics, Baylor College of
Medicine, Houston,TX; 2. Geriatrics, Michael E. DeBakey VAMC,
Houston,TX; 3. Brazos-Valley Community Agency Action, Bryan,TX.
Supported By: Nothing to disclose.
INTRODUCTION
Seniors are becoming more involved in competitive sports, and
injuries in this age group are not well described. We report a patient
who suffered traumatic brain injury with multisensory loss.
CASE PRESENTATION
A 74 year old Caucasian clinic nurse presented to the ER after
she was bumped into, fell backwards, and struck her head on the hard
court while playing basketball. She had brief LOC, bled from her
right ear canal, and reported hearing loss and severe dizziness.
Past medical history was significant for breast cancer in remission,
treated with an aromatase inhibitor, and severe osteoporosis,
treated with Calcium, Vitamin D, and alendronate. Head CT showed
bilateral temporal bone fractures, bleeding in both mastoids, contracoup
injury to the left frontal lobe, and subdural hematoma/subarachnoid
hemorrhage.
She was treated nonsurgically and discharged after 72 hours.
Dizziness was severe but responded to Eppley’s maneuver, followed
by vestibular home exercises. She had moderate symmetrical bilateral
sensorineural hearing loss of 40-50 dbl with minimal improvement
over 6 months.
She also suffers from complete anosmia and dysgeusia. The patient
returned to work after 8 weeks but struggled with patients’
names and short-term memory. Electronic records and her high preinjury
skills and medical knowledge acquired over many years compensated
for her losses.
This patient quit all her athletic activities except walking and expressed
that her losses are worse than when she faced cancer.
DISCUSSION
With the baby-boomers now turning 60, a more active generation
of elderly who may still actively participate in competitive sports
AGS 2012 ANNUAL MEETING
S25