A 52-year-old man presents with a 6-month history of progressive cognitive decline and personality changes. He reports gait disturbance and frequent falls. Vital signs: BP 138/82, HR 92, RR 16, Temp 37.2°C, SpO2 98% on room air. Examination reveals increased tone, hyperreflexia, and extensor plantar responses bilaterally. Brain MRI demonstrates asymmetric cortical and white matter atrophy with T2/FLAIR hyperintensities in periventricular regions. CSF protein is mildly elevated at 58 mg/dL. No fever or meningismus noted. Which diagnosis best explains these findings?
- A)Chronic hepatic encephalopathy
- B)Metachromatic leukodystrophy
- C)Relapsing-remitting multiple sclerosis
- D)AdrenomyeloneuropathyGABARITO
- E)Alzheimer disease
Explicação
Progressive cognitive decline with pyramidal signs (hyperreflexia, extensor plantar response) and asymmetric white matter lesions in a middle-aged man suggests adrenomyeloneuropathy (AMN), the adult form of X-linked adrenoleukodystrophy with demyelination, mye... Ver explicação completa e trilha adaptativa →