BOF: 121
A 63 year old
male is referred to the clinic for assessment. He is accompanied by his wife
who says that the patient has been getting confused and is finding it
increasingly difficult to cope with simple day to day tasks. There are no
significant past illnesses as far as the wife can recall and he does not
recall any significant illnesses either. He is not on any medication. He
smokes 20 cigarettes a day and has done so for 40 years. He takes about 12
units of alcohol a week. He was a businessman in the past but retired early.
They have 2 grown up children.
On examination
you note that the patient is not oriented well in place time and person and
has poor recall for recent events and is unable to perform simple arithmetic.
On neurological
examination you note that he his pupils react poorly to light although they do
react to accommodation.
In this patient
which one of the following investigations would you arrange next?
a)
HIV antibody
b)
MRI of the
brain
c)
Lumbar puncture
d)
TPHA
e)
Chest X-ray
