Case 35-2008 -- A 65-Year-Old Man with Confusion and Memory Loss

doi:10.1056/NEJMcpc0804643

Volume 359:2155-2164		November 13, 2008		Number 20

Case 35-2008 — A 65-Year-Old Man with Confusion and Memory Loss

Kirk R. Daffner, M.D., Janet C. Sherman, Ph.D., R. Gilberto Gonzalez, M.D., Ph.D., and Robert P. Hasserjian, M.D.

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Presentation of Case

Dr. Roy N. Alcalay (Neurology): A 65-year-old right-handed manwas transferred to this hospital because of confusion and memoryloss. He had been well until approximately 4 weeks before admission,when he began to have decreased energy and a change in mood.He told his family that he felt as if he was "living in a fog."Three weeks before admission, he lost his way while drivingto his sister's house; 9 days before admission, he did not arrivefor his weekly visit with his aunt. When reached by telephoneat home, the patient stated that he did not know . . . [Full Text of this Article]

Differential Diagnosis

Causes of Abnormalities of the Limbic System

Limbic Encephalitis

HSV Encephalitis

Paraneoplastic Limbic Encephalitis

Clinical Diagnosis

Dr. Kirk R. Daffner's Diagnosis

Pathological Discussion

Anatomical Diagnosis

Source Information

From the Division of Cognitive and Behavioral Neurology, Brigham and Women's Hospital (K.R.D.); the Psychology Assessment Center (J.C.S.) and the Departments of Psychiatry (J.C.S.), Radiology (R.G.G.), and Pathology (R.P.H.), Massachusetts General Hospital; and the Departments of Neurology (K.R.D., J.C.S.), Radiology (R.G.G.), and Pathology (R.P.H.), Harvard Medical School — all in Boston.