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February 16, 2012

What's Your Medical Diagnosis? 75 yr Male, Memory Loss, Seizures

The Isabel tool touts an extensive database of conditions, and we often will test its accuracy with New England Journal of Medicine cases.

About the Isabel Diagnosis Challenge

The New England Journal of Medicine (NEJM) publishes interesting presentations of common diseases and unusual cases in the Clinical pathology Conference (CPC) series. These cases are educational and can pose diagnostic challenges even to the expert physicians at the Massachusetts General Hospital.

New England Journal of MedicineUsing the clinical features of these cases you can evaluate your own diagnostic skills and compare your diagnostic performance to that of the physicians at MGH. If you are registered with Isabel as a client or have a free-trial subscription, you can use the diagnosis reminder system and run through some scenarios to get a list of likely suspects. Clicking on a diagnosis will take you through to various knowledge sources and links available from within Isabel.

Today's Case

Read the full case (subscribers only): N Engl J Med. 365(19):1825-1833

A 75-year-old physician was seen in an outpatient office at this hospital because of memory loss and episodes of near-syncope.

The patient had been generally well, except for mild and gradual memory loss, until 7 months earlier, when episodes of diffuse tingling and a sensation of flushing began to occur intermittently, lasting about a minute. Light-headedness and difficulties with word finding developed 4 months before presentation in association with the episodes and progressed to near-syncope 4 weeks before presentation. The patient reported an intermittently irregular pulse but no other speech, vision, other sensory, or motor symptoms.

Demographic: Male, 75 yrs, North America
Clinical features:

  • memory loss
  • episodes of near-syncope
  • olfactory hallucination
  • dysautonomia word finding difficulty seizures

Before reading further, construct your own:

  1. Complete differential diagnosis
  2. Final diagnosis

The Answer:

Differential Diagnoses by MGH panel: Acquired epilepsy
Final Diagnosis of the case according to NEJM: Limbic encephalitis with antibodies to leucine-rich, glioma-inactivated 1 (LGl1)
Differential Diagnoses of the case as given by Isabel: Acquired epilepsy in Neuro

Do you think that the NEJM should have included some other important diagnoses in their differential? We would love to hear from you.

Was the final diagnosis given by Isabel?: Yes, Limbic encephalitis in Infectious.

Case 33 NEJM

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