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Case 26 - Something Does Not Look Right

from Part 6 - Clinical Findings That Are Subtle

Published online by Cambridge University Press:  03 November 2020

Keith Josephs ,
Federico Rodriguez-Porcel ,
Rhonna Shatz ,
Daniel Weintraub  and
Alberto Espay
Keith Josephs
Affiliation:
Mayo Clinic Alzheimer’s Disease Research Center
Federico Rodriguez-Porcel
Affiliation:
Medical University of South Carolina
Rhonna Shatz
Affiliation:
University of Cincinnati
Daniel Weintraub
Affiliation:
University of Pennsylvania
Alberto Espay
Affiliation:
University of Cincinnati
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Summary

This 60-year-old woman presented with a 2-year history of cognitive changes and hallucinations concerning for dementia with Lewy bodies (DLB). She first reported seeing a bright moving circle out of her right visual field. The image was always the same and the episodes lasted 20 seconds. Their frequency increased to five times a day over the course of six months. After each episode, she experienced a headache lasting up to an hour with no associated nausea or photophobia. She had been initially diagnosed with migraine with aura and tried propranolol, verapamil and amitryptline, to no avail. Since starting topiramate six months prior to her evaluation the frequency had reduced to about once a day. However, she felt forgetful, slower in her thinking and had difficulty finding words since initiating topiramate treatment. The development of cognitive impairment in the background of hallucinations had raised the concern for early stages of DLB. However, she denied any motor changes (i.e., parkinsonism) or sleep disturbances (i.e., symptoms of REM sleep behavior disorder).

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Chapter
Information
Common Pitfalls in Cognitive and Behavioral Neurology
A Case-Based Approach
 , pp. 83 - 86
Publisher: Cambridge University Press
Print publication year: 2020

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