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You are asked to do a consultation of an 87 y.o. grandmother with Alzheimer's Disease
and controlled hypertension at a nursing home. She has had two days of episodic
bizarre behavior. Usually quiet, she has been repeating short phrases over and over
again, swallowing air, flinging her right arm in a circular fashion, and making
kissing gestures to the nursing staff. The episodes last about a half hour and
occurred several times a day. She had a history of febrile seizures as a child.
She had been given Haldol, but it had not helped. When examined, she is not
having any episodes. She does not remember the episodes. Her physical examination
shows the signs of hypertension, grade II eye ground changes, a heart that
percussed 4 cm. to the left of the left mid-clavicular line, and a S4heart sound.
On neurological exam, she was disoriented to year and month. She did not
know the president, could not perform serial "7's" or serial "3's". Her
gait was slow with some shuffling and a tendency to turn "en masse". There
was no bradykinesia, not tremor, and no rigidity. She had prominent snout,
suck and palmo-mental reflexes. Her motor and sensory examinations were
normal. Her deep tendon reflexes were 2+ and symmetrical.
Questions:
- You feel that she may have seizures and recommend admission
to the epilepsy monitoring unit at Stony Brook. Which kind of seizures
might she have?
- What would you expect to see on her EEG during an episode
if these seizures are the cause of her problem?
- Is there a relationship of Alzheimer's Disease and seizures? Speculate
on a possible mechanism.
- If the patient does have the type of seizures that you proposed in
question #1, how would you treat them?
- What is the differential diagnoses of these episodic behavior abnormalities
(Name at least two other causes in Alzheimer patients)?
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