67M Dementia with headache

 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box"

67 year old male resident of gundepalli complaints of headache since 15 days

HOPI: patient was apparently asymptomatic until 15 days back. Then he had insidious onset of unilateral headache left side dragging pain radiating to neck accompanied with decreased intenditor speech , decreased fluency . Memory loss

No c/o fever , fatigue , giddiness

No c/o cough/ cold 

No c/o burning micturition

No c/o nausea, vomitings, loose stools

PAST HISTORY:

Not a known case of Dm/HTN/TB/asthma/epilepsy 

PERSONAL HISTORY :

normal appetite 

Mixed diet

Regular bowel and bladder movements 

No known allergies

No addictions

FAMILY HISTORY: Not significant 

GENERAL PHYSICAL EXAMINATION:

No pallor icterus cyanosis clubbing lymphadenopathy 

Vitals:

Bp-110/80mmhg

Pr-100bpm

SYSTEMIC EXAMINATION:

CVS: S1s2 +, No murmurs 

Rs: BAE+, NVBS heard 

PA: soft ,non tender 

CNS:

1-Informant: Lukapati

2-Education: uneducated,illiterate 

3-Occupation :farmer (stoped 6months back)

4-Handedness: right

5-Physical appearance: 

a)personal cleanliness : good

b) dressing habits :

c) motor activity : masked like face

6-Attention( non spatial)

7-Attention( spatial)

8-Mood ,emotion , behavior-normal

9-language 

Spontaneous speech:normal word output

Verbal fluency:

Comprehension:

Repetition:

Naming:

Reading:

Writing:

10-Memory

Immediate:

Recent/short term memory

Report memory: Intact , 

visual memory +

11- Higher cognitive function testing

12- apraxia

Ideo motor apraxia:

Ideational apraxia:

TEMPORAL LOBE

Memory:

Recent memory -intact

Remote memory -intact

New learning ability 

Visual memory

PARIETAL LOBE

1- neglect

2-simultagnosia 

3-apraxia

4- constructional ability

5- calculation : 

simple addition+

Substraction -

Multiplication +

6- right left orientation

7- finger agnosia

8-geographic orientation 

9-cortical sensation 

Stereognosis

Graphesthesia

FRONTAL LOBE

1. attention/working memory
2. Set shifting 
3. Trail b test
4. Sequence test 
5. Verbal similarities
6. Verbal fluency 
7. Conflicting instructions/ sensitivity to interference 
8. Inhibitory control
9. Proverb interpretation 
10. Environmental/autonomy
11. Judgement 
12. Insight

OCCIPITAL LOBE

1.prosopagnosia

1. Visual object agnosia