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My 62 Year Old Husband Was Sent Home From His Job Several Weeks Ago For Mistakes And Lack Of Concentration. MRI Without Contrast Normal, Labs Metals Normal And Now A PET Scan Normal. He Is Still Very Confused And Difficulty With Simple Sentences And Saying A Prayer. He Has Had Eight Surgeries Due To A Hunting Accident In 1993. Any Suggestions?

Posted on Tue, 14 Feb 2023

Question: Hi there thank you. My 62 year old husband was sent home from his job several weeks ago for mistakes and lack of concentration. MRI without contrast normal, labs metals normal and now a PET scan normal. He is still very confused and difficulty with simple sentences and saying a prayer. He has had eight surgeries due to a hunting accident in 1993. Any suggestions? We are desperate as he will lose his job and medical insurance.

Answered by Dr. Sudhir Kumar (44 minutes later)

Brief Answer:
He needs further evaluation.

Detailed Answer:
Hi,

I am Dr Sudhir Kumar, Neurologist, and would try my best to help you.I have noted your husband's clinical details. He needs further evaluation. This would include:

1. Lumbar puncture- to rule out central nervous system infection,

2. Detailed neuro-psychological assessment to determine the brain functions affected, which can further help in making the diagnosis,

3. Psychiatry consultation to rule out psychosis,

4. EEG- to rule out subclinical seizures and to get further insights into his brain dysfunction.

5. Blood tests- I presume these may have been done- thyroid profile, vitamin B12, thyroid antibodies.

I sincerely hope my reply has helped you.

I would be pleased to answer, if you have any follow up queries or if you require any further information.

Thanks.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Sudhir Kumar (16 hours later)

Thank you. This is flipped our world. We think he will not be able to return to work, a steel mill. Given the fact of normal MRI/PET scan, is there the possibility of dementia. Memory is really horrible.
Yes the labs you mentioned were done all normal but taking Vitamin B12 injections. LP was also mentioned.
Also due to accident o. Early 80’s lower leg is significantfully smaller in mass.
Tganks

Answered by Dr. Sudhir Kumar (11 hours later)

Brief Answer:
Yes, it could be dementia.

Detailed Answer:
Thank you for getting back with more information.

I know it is a difficult situation for the patient as well as family members.

Investigations including MRI brain and routine PET may be normal in people with dementia. In these cases, a neuropsychological assessment could be helpful in confirming the diagnosis of dementia.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar