A 55-year-old female presented to the outpatient with a forgetfulness complaint from the past three years. She had a H/o clumsiness of movements, slowness in performing daily tasks, decreased attention span and depressed mood. She had been experiencing unprovoked falls for the last two years. She had a significant history of minor trauma due to falling at inappropriate places.
The patient has been a known hypertensive (uncontrolled for two years), on and off medication. Family history was not significant. The patient was cooperative, conscious, and responsive to commands on the neurological examination—Glasgow coma scale - E 4 V 5 M 6. Mini-Mental Status Examination revealed inference of Mild cognitive impairment (score: 20/30). The patient exhibited an unsteady gait.
On laboratory investigations, the patient was found to have dyslipidemia and type 2 diabetes mellitus. Her hemogram, liver, and kidney function tests were normal. However, an MRI of the brain showed a hemorrhagic infarct in the right thalamus with extensive chronic ischemic white matter lesions with multiple microhemorrhages, as shown in the figure.
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