A 52-Year-Old Man Is Evaluated for Ongoing Cognitive Difficulties

A 52-year-old man is evaluated for ongoing cognitive difficulties.  For the past 2 months, he has been sleeping 12-16 hours daily, much more than he usually does.  When he is awake, he is withdrawn and less socially engaged than normal.  During this time, the patient has had trouble driving, sideswiping cars on the right side of the road more than once.  He also has had several falls, which he attributes to feeling off-balance.  Vital signs are normal.  The patient scores 22/30 (normal: ≥26) on the Montreal Cognitive Assessment.  A partial right homonymous hemianopsia is noted.  Motor and reflex examinations are normal with intact vibratory sensation.  He exhibits dysdiadochokinesia and dysmetria on testing of his upper and lower extremities along with a wide-based gait.  CT scan of the head is normal.  Real-time quaking-induced conversion testing of his cerebrospinal fluid is positive.  This patient will most likely develop which of the following?

A) Cogwheel rigidity
B) Flaccid paralysis
C) Multiple cranial neuropathies
D) Myoclonus
E) Peripheral neuropathy

Correct Answer:

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