BackgroundWith aging of society the absolute number and the proportion of patients with cognitive deficits increase. Multiple disorders and diseases can foster cognitive impairment, e.g., Alzheimer’s disease (AD), depressive disorder, or polypharmacy.Case presentationA 74 year old man presented to the Old Age Psychiatry Service with cognitive deficits while being treated for recurrent depressive episodes and essential tremor with Venlafaxine, Lithium, and Primidone. Neuropsychological testing revealed a medio-temporal pattern of deficits with pronounced impairment of episodic memory, particularly delayed recall. Likewise, cognitive flexibility, semantic fluency, and attention were impaired. Positron emission tomography (PET) with fluorodeoxyglucose was performed and revealed a pattern of glucose utilization deficit resembling AD. On cessation of treatment with Lithium and Primidone, cognitive performance improved, particularly episodic memory performance and cognitive flexibility. Likewise, glucose metabolism normalized. Despite normalization of both, clinical symptoms and glucose utilization, the patient remained worried about possible underlying Alzheimer’s disease pathology. To rule this out, an amyloid-PET was performed. No cortical amyloid was observed.ConclusionPharmacological treatment of older subjects may mimic glucose metabolism and clinical symptoms of Alzheimer’s disease. In the present case both, imaging and clinical findings, reversed to normal on change of treatment. Amyloid PET is a helpful tool to additionally rule out underlying Alzheimer’s disease in situations of clinical doubt even if clinical or other imaging findings are suggestive of Alzheimer’s disease.
Our data show a positive correlation between age and CBD diameter. There was no statistically significant relationship between CBD diameter and prior cholecystectomy, postoperative interval and BMI.
We present an 18-year-old patient with Henoch-Schönlein purpura (HSP) who had multiple episodes of severe acute renal failure, including one episode for which he required hemodialysis for 2 months and a second episode for which dialysis was considered before his spontaneous recovery of renal function. Multiple treatment options, including steroids, mycophenolate mofetil, cyclophosphamide, and plasmapheresis, were tried but we could not confidently point to the utility of any of these measures. We highlight the unusual severity and lability of our patient's clinical course and how such a course makes the evaluation of treatment effectiveness extraordinarily difficult.
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