A woman in Massachusetts left doctors puzzled when her dementia caused a frighteningly rapid decline.
In just five months, the 78-year-old went from living independently to having difficulty forming sentences and needing help with basic tasks like bathing and eating.
A few weeks before the deterioration, a family member had died, so the woman’s daughter attributed the symptoms to grief — until it became clear that something was seriously wrong.
Doctors struggled to make a diagnosis, meaning the woman was repeatedly referred for tests at some of the top hospitals, including Massachusetts General Hospital, Harvard Medical School, the University of Pittsburgh and the University of Calgary.
The 78-year-old woman began experiencing unexplained rapid and severe cognitive decline (stock photo)
She was eventually diagnosed with undiagnosed lung cancer that had spread to her lymph nodes and a toxic buildup of amyloid proteins in her arteries.
The woman was diagnosed with paraneoplastic encephalomyelitis (PEM), an inflammation of the brain and spinal cord that causes confusion, brain hemorrhages, cognitive decline and difficulty thinking and speaking – similar to Alzheimer’s disease.
PEM is a rare neurological disorder that affects less than one in 100,000 people each year.
It is caused by the presence of cancer somewhere in the body.
The patients case was described in The New England Journal of Medicine.
According to doctors, her symptoms began with a “flat mood,” which the patient’s daughter attributed to grief following the death of her sister.
Subsequently, ‘more serious memory problems’ developed and she was admitted to hospital after a terrifying episode in which she had difficulty speaking.
An MRI scan showed that her brain tissue was damaged by repeated lack of blood supply, suggesting she may have suffered a stroke.
But without conclusive answers, the doctors sent her home. Just 10 days later, the patient became more impulsive, confused and forgetful.
Her GP prescribed medication to treat “possible depression.”
In the weeks that followed, the woman’s condition deteriorated rapidly and she increasingly needed help with daily activities and washing, and she also had to be reminded to eat.
The above brain scans may indicate a stroke, damage to brain tissue, and narrowing of the blood vessels in the brain.
About four months later, her daughter took her back to the hospital, where she underwent more extensive testing, including blood work, a spinal tap, X-rays, and another MRI.
Tests revealed the woman had brain abnormalities, with damage to brain tissue and blood vessels, affecting the organ’s blood and oxygen supply.
After the official diagnosis, the patient underwent treatment with steroids, but she did not receive chemotherapy because her family was concerned about her poor memory and confusion.
However, she underwent immunotherapy for six months.
The patient was also given an anti-seizure medication, and the case report authors wrote that her confusion decreased somewhat and her level of consciousness improved.
She was discharged from hospital and placed in a nursing home with a course of steroids, but she became paranoid and confused and her memory deteriorated.
When her steroid treatment ended, she developed respiratory failure and pneumonia and was admitted to the intensive care unit. When her condition began to deteriorate, the family chose not to intervene and instead provided end-of-life comfort care.
The woman died in a hospice.
