07-28-2015, 04:27 AM
A previously healthy 65-year-old man comes to medical attention because of increasingly severe memory disturbances, loss of balance, and urinary incontinence for 10 months. His vital signs are normal. Mini-mental status examination shows mild-to-moderate short-term memory deficits. Laboratory screening tests are within normal limits. Papilledema is absent on funduscopic examination. Magnetic resonance imaging reveals dilated ventricular spaces, while the cortical mantle is normal, without widening of sulci or narrowing of gyri. The white matter appears unremarkable, with no evidence of demyelination. A lumbar puncture yields the following values: CSF pressure............120 mm H20
Cell count.................3 lymphocytes/mm3
Glucose....................54 mg/dL
Proteins, total............29 mg/dL
Which of the following is the most appropriate next step in management?
A. Culture of CSF
B. Trial with cholinesterase inhibitors
C. Treatment with antidepressant drugs
D. Treatment with levodopa
E. CSF shunting procedure
Cell count.................3 lymphocytes/mm3
Glucose....................54 mg/dL
Proteins, total............29 mg/dL
Which of the following is the most appropriate next step in management?
A. Culture of CSF
B. Trial with cholinesterase inhibitors
C. Treatment with antidepressant drugs
D. Treatment with levodopa
E. CSF shunting procedure