Case 14

A seventy three-year-old female was transferred to our hospital from local hospital. Seven days ago, she had been admitted to the local hospital because of sudden convulsion and speech disturbance. The convulsion was recovered but no improvement of speech disturbance was found. She was scheduled to take speech rehabilitation in our hospital. At admission (Day1), she preserved the memory of the present episode and the motor function but cognition impairment was found. She had a head-floating feeling and appealed the disability of eating. Further, although she was originally hard to hearing, her hearing loss had worsened since this time episode. Her blood pressure revealed 102/64 mm Hg. She received MRI. In the morning of Day 7, her speaking disturbance with incoherence worsened. Right hand tremor, handwriting disability and convulsion with intermittent facial paralysis were newly found. Her constrictive blood pressure fluctuated from 160 to 130 mmHg. She received MRI again. Laboratory test: white blood cells of 4000 / mm³ and CRP of 0.78 mg/dl and mononuclear cytes of 11.4 %.

Which is the clinical diagnosis ?

1.Cranial multiple hemangioma

2.Hypertensive brain hemorrhage

3.Cerebral amyloid angiopathy

4.Binswanger’s disease

5.Mitochondrial encephalopathy, lactic acidosis, and stroke-like syndrome (MELAS)

answer

2016.7.13