A 72-Year-Old Man with Rapid Cognitive Decline

Morning Report is a time-honored tradition where physicians-in-training present cases to their colleagues and clinical experts to collaboratively examine an interesting patient presentation. The Morning Report section seeks to carry on this tradition by presenting a patient’s chief concern and story, inviting the reader to develop a differential diagnosis and discover the diagnosis alongside the authors of the case. This report examines the case of a 72-year-old man with four weeks of fatigue, headaches, and intermittent leg weakness who presented to the hospital with acute confusion. He subsequently had a profound functional and cognitive decline. Using questions, physical examination, and testing, an illness script for the presentation emerges. As the clinical course progresses, the differential is refined until a diagnosis is made.