Chief Complaint Case Study

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Chief Complaint

Patient is a 74-year-old right-handed white female who has had three stereotypical events one on 2012, and two this July. She describes it as "my brain goes into a cramp and I can not speak". She states that she knows what she wants to say, but can not find the words or pronounce the words properly. She calls it jumbled speech. Her first event, again was in 2012 and it lasted less than a minute. She had a second event on July 3rd, when she was on the phone and suddenly could not use the correct words, and the third event occurred on July 7th of this year, when she was reading something on the computer to her husband, all of the sudden she could see what she wanted to read, she could understand the words, but she could not make her mouth work to get the words out. Again, these all last less than a minute. There is no other cognitive component to this. There is no change in contact with the environment. There is no facial droop or numbness or tingling. There is no right-sided weakness. There is no right-sided sensory loss. She denies any gaps in her memory. She denies any seizure-like auras or increased Deja vu. She has not had any episodes
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There is significant white matter changes, which is rather confluent, especially in the parietal occipital lobes. At this point, I doubt that this is progressive multifocal leukoencephalopathy, as she is not immunocompromised. It is not consistent clinically with posterior reversible encephalopathy syndrome, as she does not have any marked hypertension and there is no headache, confusion or visual changes. She is too old to be suffering from most of the leukodystrophies. At this point, I do not think that the three events that she had were transient ischemic attacks . They seem to come on paroxysmally and last less than a minute, and by her description sound more like a speech arrest. I am concerned that this may represent simple partial

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