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Case Records of the Massachusetts General HospitalFree Preview

Case 1-2021: A 76-Year-Old Woman with Lethargy and Altered Mental Status

List of authors.
  • Lisa M. Bebell, M.D.,
  • R. Gilberto Gonzalez, M.D., Ph.D.,
  • Amy K. Barczak, M.D.,
  • and Melis N. Anahtar, M.D., Ph.D.

A 76-year-old woman with a history of gastric adenocarcinoma and chronic kidney disease presented with lethargy and altered mental status. She had anemia and thrombocytopenia; MRI showed foci of restricted diffusion in the left cerebellar hemisphere and right frontal lobe. A diagnostic test was performed.

Funding and Disclosures

This case was presented at the Medicine Case Conference.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

We thank Drs. Nesli Basgoz and Rocio Hurtado for their input and Dr. Richard Schaefer and Sharon Schaefer (deceased) for their roles in helping to develop the discussion.

Author Affiliations

From the Departments of Medicine (L.M.B., A.K.B.), Radiology (R.G.G.), and Pathology (M.N.A.), Massachusetts General Hospital, and the Departments of Medicine (L.M.B., A.K.B.), Radiology (R.G.G.), and Pathology (M.N.A.), Harvard Medical School both in Boston.

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