Approach to encephalopathy (acute and subacute) Quiz: Ace Your Exams
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A 60-year-old woman is brought to the emergency department for evaluation of altered mental status. Over the past two months, the patient has become increasingly withdrawn, exhibiting confusion, memory loss, and a noticeable reduction in both speech and movement. Recently, the patient has not spoken at all and has developed intermittent, quick jerks of the bilateral upper extremities. Past medical history includes gastroesophageal reflux managed with omeprazole. Temperature is 37.0°C (98.6°F), pulse is 68/min, respirations are 16/min, and blood pressure is 118/76 mmHg. Liver, kidney, and thyroid function tests are normal, and a urine toxicology screen is negative. Magnetic resonance imaging (MRI) of the brain shows cortical ribboning on diffusion-weighted imaging sequences, and continuous video electroencephalography (EEG) shows periodic sharp wave complexes. Which of the following additional tests is most likely to confirm the underlying cause of these symptoms?
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