Part 6: Traumatic Brain Injury: Rehabilitation Neurology
Questions 1-3 Refer to the Following Case:
- A 45-year-old former bank executive presents to a
neurologist after being discharged from a subacute
inpatient facility 6 months after he received a severe
closed head injury in a motor vehicle accident. He is
able to ambulate independently but continues to have
residual difficulties with functional use of his right
hand, distractibility, disorganization, and poor longterm
memory as well as irritability and anger outbursts.
The patientís anger outbursts are occasionally violent
and can seem unprovoked, but they tend to be triggered
by episodes where others point out information
that he was told but cannot remember.
The patient improves and makes an attempt to return to working after 1 year. The patient performs relatively well with a limited work schedule and activities tailored to his current abilities, although he is no longer managing in an executive role. However, 2 months into work the patient seems to be declining rather than improving, with his performance worsening over the course of several weeks. Colleagues describe him as slowing down, showing poor concentration, and not keeping up with his limited list of tasks. As part of the evaluation, the neurologist orders a routine complete blood count and chemistries, a computed tomography scan, and electroencephalography. Which of the following potential causes of decline would require additional evaluation?
Updated 12/03/2014 • jdw | Copyright ©2014 Turner White Communications