Question of the Week # 412

412)  An 78 year old man with history of dementia is evaluated in your office for three episodes of “syncope” over the past two months. He lives with his daughter at home. She reports that he fell to the floor and lost consciousness in the morning after getting up from his bed and the episodes would last for few minutes but he would return to his usual baseline mental status after the event. There is no history of chest pain or shortness of breath.  She has seen him become increasingly “stiff” over the years and he has had worsening of tremors in his hands. When he writes, the letters are very small and difficult to decipher.  He has been taking Donepezil and Memantine for Alzheimer’s for about 2 years.  On examination, his pulse is 90/min, Blood Pressure 110/60 mm Hg. He has Bradykinesia and Pill rolling tremor in his hands. Cardiac examination is normal with out any murmurs. Laboratory investigations revealed a normal hemoglobin, blood glucose and electrolytes. An electrocardiogram is within normal limits. Which of the following is indicated next?

A) Orthostatic Vitals

B) 24 hour Holter-Monitoring

C) Discontinue Memantine and Donepezil

D) CT Scan of the Head

E) Tilt-Table Test

10 Responses

  1. C) Discontinue Memantine and Donepezil

  2. Falling after getting up from his bed and then returning to baseline mental status after the fall.. i think its orthostatic hypotension..so its

    A) Orthostatic Vitals

    Although Memantine may cause confusion and dizziness he does not have it all the time..so its not due to medication.

    Next step

    D) CT Scan of the Head

  3. Falling after getting up from his bed and then returning to baseline mental status after the fall.. i think its orthostatic hypotension..so its

    A) Orthostatic Vitals

    Although Memantine may cause confusion and dizziness he does not have it all the time..so its not due to medication.

    Next step,do

    D) CT Scan of the Head

  4. Shy drager syndrome -Parkinson’s and autonomic dysfunction

    We have to check orthostatic vitals -A

  5. E

  6. a

  7. C.

  8. A- hints to orthostatic hypotension as the fall is experienced after getting up from bed…lasting a few mins…return of mental status to baseline following the event.

  9. A. check (neurologic) orthostatic hypotension.Multiple system atrophy that resembles parkinson

  10. A-its orthostatic hypotension the disease is parkinson plus syndrome that is
    shy drager syndrome

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