A 67-Year-Old Man Is Brought to the Office Due to Progressively

A 67-year-old man is brought to the office due to progressively worsening insomnia and impaired concentration and judgment for 2 months.  Medical history is significant for early-stage non-small cell lung cancer that was resected 5 years ago.  The patient currently takes no medications.  Vitals signs are within normal limits.  On examination, he is alert and oriented.  The patient has limited language and difficulty remembering objects and names.  Horizontal nystagmus is present.  Mild spasticity, myoclonus, and hyperreflexia are present.  Gait is wide based and unsteady.  Cardiopulmonary and abdominal examinations show no abnormalities.  MRI of the head reveals cerebral atrophy and diffuse bright signals in the cortical white matter and portions of the basal ganglia; there are no mass lesions.  Which of the following is the most likely diagnosis?

A) Carbon monoxide poisoning
B) Leptomeningeal carcinomatosis
C) Prion disease
D) Thiamine deficiency
E) Wilson disease

Correct Answer:

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