Given these changes from the original case, what is your diagnosis?
What is your diagnostic explanation?
As compared to the long case, this patient is a 20 year old man who presents to the Emergency Department on the insistence of his mother, who is concerned that his mood has changed.
HPI: Patient is disoriented and confused; his mother is the main historian, and she is quite concerned about her son. He is a student at the local college, and for the last couple of years she has noticed subtle changes in his personality and the crowd he hangs around with. This has gotten much worse over the last 2 months or so. She reports that her son began staying out late during college and would occasionally come home intoxicated, which worried her but she thought he was just doing what normal college kids do. For the last couple of months, however, she has noticed that her son sometimes will not return home for days at a time and she cannot contact him. Over the last week or so, he has become progressively confused and agitated. He falls down a lot at home and seems to have trouble walking. She brought him in today because she is really concerned that his mental status is worsening.
PMH: Same as in the long case.
SH: When asked about alcohol use, he says “I’m in college, can you blame me for having a few drinks at night?” Denies tobacco and drug use.
ROS: Difficult to obtain because patient is disoriented and doesn’t answer to direct questioning.
General: He appears lethargic and inattentive.
HEENT: nystagmus and conjugate gaze palsy.
Neuro: gait is ataxic, patient has trouble standing without assistance.