A 52-year-old male with primary education consulted due to progressive memory, language and mood disorders over the previous 2 years in the absence of trauma, stroke or symptoms.
The patient and his family reported easy forgetfulness, spatial disorientation in their locality and in their own homes, clumsiness when dressed, although he did so and progressively made mistakes in a more autonomous way.
He was on sick leave because he did not perform his duties properly (amount of furniture), and did not lead to being insecure.
She did not mention relatives or relatives, but forgot recent facts by those who immediately asked again.
She was being treated with mitopine (30 mg), and pravastatin.
She had a history of hypercholesterolemia, hepatic steatosis, and depressive symptoms.
He did not consume excessive alcohol and reported weight loss as the only physical symptom.
His mother had dementia started at the age of 75 years.
In his first exploration, he was alert, slow, and dubitative in his answers, well oriented in space and medianly in time, forgetting details about events that occurred the same day.
Appropriate name of usual objects, but with dysphasic errors in their spontaneous language
Dyscalculia and dyspraxia of the dress
He did not write sheets and interpreted gestures, but did not manage abstract concepts.
clock test 6/7.
MMSE (Folstein): 25/30.
Adas Cog: 15.
Blessed Scale: 10/28.
Her physical examination showed only diffuse exhalation in the stretching reflexes, without Babinski, with the rest of her examination and normal eye fundus.
The following blood tests were normal: blood count, ESR, TSH, free T4, general biochemical, hepatic and renal, B12, folic, calcium, copper, ceruloplasmin, complement, serology to lú.
Brain MRI without contrast: normal.
The patient was diagnosed with early Alzheimer-type dementia, and treatment with rivastigmine was started in ascending doses up to 6 mg daily.
However, the clinical evolution was unfavorable, with emphasis on cognitive impairment, with the appearance of tremor parkinsonism, Hoehn-Yahr stage III, and visual disturbance.
Treatment with bromazepam/ropinirole (1.5 mg/day), memantine (20 mg/day), bromazepam (6 mg/day), 800 mg/day L-dopa/carbidopa, Ambroxol)
An EEG showed only slight nonspecific diffuse slowing.
Cerebral SPECT showed bilateral hypouptake, more severe in left striatum.
A new cerebral magnetic resonance imaging showed diffuse cerebral malformation, with no focal predominance.
Genetic study of the protein associated with Tau microtubules did not detect mutations in this gene.
Finally, diffuse amyotrophies appeared, and an oculorrhythmia was identified as an exploratory finding. This finding guided a possible brain Whipple disease, which was normal by means of a glucose screening test (0.3 mg).
Finally, after the definitive diagnosis of Whipple's disease, treatment with trimethoprim and cotrimoxazole was established.
During the first year of antibiotic treatment the patient has stabilized in his symptomatology.
