Differential Diagnosis
- Single most likely diagnosis
- F) Wernicke encephalopathy: This diagnosis is the most likely due to the patient's symptoms of confusion, worsening memory, cerebellar ataxia, bilateral ophthalmoparesis, and unsteady gait. The patient's significant unintentional weight loss and immigration from Southeast Asia, where nutritional deficiencies are more common, also support this diagnosis. Wernicke encephalopathy is a medical emergency caused by thiamine deficiency, often seen in malnourished individuals.
- Other Likely diagnoses
- A) Creutzfeldt-Jakob disease: This is a possible diagnosis given the patient's rapid decline in memory and cognitive function, as well as her cerebellar ataxia. However, Creutzfeldt-Jakob disease typically presents with myoclonus and a more rapid progression of symptoms.
- B) Dementia, Alzheimer type: While the patient's memory issues and confusion could be consistent with Alzheimer's disease, the rapid progression of symptoms and presence of cerebellar ataxia and ophthalmoparesis make this diagnosis less likely.
- Do Not Miss
- E) Viral encephalitis: Although less likely, viral encephalitis is a potentially life-threatening condition that requires prompt diagnosis and treatment. The patient's symptoms of confusion, memory loss, and cerebellar ataxia could be consistent with viral encephalitis, particularly in an immunocompromised individual.
- C) Normal pressure hydrocephalus: This condition can present with cognitive decline, gait disturbances, and urinary incontinence. While the patient's symptoms do not perfectly align with normal pressure hydrocephalus, it is a diagnosis that should be considered to avoid missing a potentially treatable condition.
- Rare diagnoses
- D) Pseudodementia: This is a condition where depression or other psychiatric disorders mimic dementia. While possible, the patient's significant weight loss, cerebellar ataxia, and ophthalmoparesis make this diagnosis less likely.
- Other rare diagnoses, such as vitamin B12 deficiency or neurosyphilis, could also be considered, but are less likely given the patient's presentation and lack of other supporting symptoms.