Differential Diagnosis
- Single most likely diagnosis
- B) Death of substantia nigra neurons: This is the most likely diagnosis given the patient's symptoms of tremor, memory lapses, and behavioral changes. The presence of a fine tremor in the upper extremities and the patient's attempt to alleviate it with alcohol suggest Parkinson's disease, which is characterized by the death of substantia nigra neurons.
- Other Likely diagnoses
- A) Amyloid plaques: The patient's memory lapses and mild generalized atrophy on MRI suggest possible early-stage Alzheimer's disease, which is characterized by the presence of amyloid plaques.
- E) Vitamin B12 (cobalamin) deficiency: The patient's symptoms of irritability, paranoia, and memory lapses could be related to a vitamin B12 deficiency, which is a known cause of dementia and neuropsychiatric symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- D) Vitamin B1 (thiamine) deficiency: Although less likely, a thiamine deficiency (Wernicke-Korsakoff syndrome) could present with similar symptoms, including memory lapses and tremors. This condition is medical emergency that requires prompt treatment.
- Rare diagnoses
- C) Degeneration of lateral horn cells: This is a rare condition that affects the spinal cord and is not directly related to the patient's symptoms. It is unlikely to be the underlying cause of this patient's presentation.