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Clinical Reasoning: A 66-Year-Old Female Patient With Rapidly Progressive Memory Changes
Jennifer A Fokas1, KuangHua Guo1, Melissa Mejia Bautista2
1Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL; and.
Neurology
|September 26, 2025
Summary
This case study highlights a challenging diagnosis of rapidly progressive dementia in a 66-year-old female. The patient
Area of Science:
- Neurology
- Neuroscience
- Medical Case Reports
Background:
- Rapidly progressive dementia presents a diagnostic challenge.
- Systemic evaluation is crucial for identifying underlying causes.
- Autoimmune encephalitis is a treatable cause of dementia.
Purpose of the Study:
- To present an instructive case of atypical autoimmune encephalitis.
- To discuss the diagnostic challenges in rapidly progressive dementia.
- To highlight the importance of a comprehensive differential diagnosis.
Main Methods:
- A 66-year-old female with 3 months of memory loss was evaluated.
- Neuroimaging (MRI) and lumbar puncture were performed.
- A broad systemic workup for various etiologies was conducted.
Main Results:
- MRI revealed symmetric thalamic and temporal lobe hyperintensities.
- Lumbar puncture showed no inflammatory profile.
- Initial treatment for autoimmune encephalitis yielded only mild improvement, followed by complications.
Conclusions:
- Atypical presentations of autoimmune encephalitis can mimic other dementias.
- Comprehensive evaluation and a high index of suspicion are vital.
- This case underscores the complexity of diagnosing and managing dementia.
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