CASE 12: PERSONALITY CHANGE
History
A 64-year-old investments manager is causing increasing concern to his wife owing
to increasing forgetfulness and irritability. His mother died 3 years previously from
Alzheimer’s disease, and his wife is concerned that he is dementing. She had also noticed
that he has been drinking more fluid and getting up 2–3 times in the night to pass urine.
She persuaded him to see their general practitioner (GP) who found no symptoms of pro-
statism, and no other relevant past or family history. There was no objective evidence
of dementia, and physical examination was normal, including rectal examination.
Investigations showed normal urine, fasting blood glucose, urea, creatinine and elec-
trolytes. A wait and see policy was advised with as much reduction in stress as possible
and adequate sleep.
Over the next 2 months his colleagues begin to question his performance, then one day at
work he collapses with severe and sudden-onset left loin pain, radiating down the left
flank to his groin and left testicle. The pain is colicky and accompanied by nausea and
vomiting. He is taken to the emergency department.
Examination
The only physical abnormalities are pallor, sweating, and slight left loin tenderness.
Questions
- What is the likely diagnosis?
- What other investigations would you perform?
NormalHaemoglobin 14.0 g/dL 13.3–17.7 g/dL
White cell count 9.9% 109 /L 3.9–10.6% 109 /L
Platelets 234 % 109 /L 150–440% 109 /L
Sodium 141 mmol/L 135–145 mmol/L
Potassium 3.9 mmol/L 3.5–5.0 mmol/L
Urea 6.5 mmol/L 2.5–6.7 mmol/L
Creatinine 111 &mol/L 70–120&mol/L
Random glucose 5.2 mmol/L 4.0–6.0 mmol/LUrine: – protein;'''blood