Case Report: Weakness and Recurrent Falls in an Older Patient

Area of Science:

• Neurology
• Geriatrics
• Oncology

Background:

• Lower-extremity weakness in older adults is a common yet often overlooked issue contributing to falls.
• Potential causes include vision, balance, mobility, and neuropathy impairments.
• This case presents a diagnostic challenge in an older adult with bilateral weakness and falls.

Observation:

• A patient with a neuroendocrine tumor history developed progressive lower-extremity weakness, oculomotor, and facial muscle involvement.
• Elevated cerebrospinal fluid protein suggested infectious or autoimmune processes.
• Extensive testing ruled out common conditions like Guillain-Barré syndrome, Lyme disease, and tuberculosis.

Findings:

• Despite thorough investigation, a definitive cause remained elusive.
• The patient's condition was attributed to carcinomatosis meningoencephalitis, a rare cancer complication.
• Progressive symptoms and lack of treatment led to palliative care.

Implications:

• Emphasizes the need for broad differential diagnoses in older adults with unexplained weakness and falls.
• Highlights the importance of considering rare neurological conditions alongside common ones.
• Underscores that early identification of reversible causes is crucial, but rare pathologies must also be considered.