Progressive Neurocognitive Decline

History of Present Illness

A previously healthy 27 year old female presents to the emergency department (ED) with bilateral jaw dislocation. She is unable to provide her medical history due to her dislocated jaw; therefore, clinical information is obtained from her parents. The patient was fully independent living with her parents until two months prior when they began noticing progressive cognitive decline. They first noticed that the patient started having problems with her daily tasks. It was more difficult for her to stock shelves at work, and she began skipping steps of routine activities, such as not using soap in the shower. Two weeks ago, she started slurring her speech, perseverating, and having a difficult time focusing. They brought her to her primary care physician, who ordered bloodwork and a brain MRI. The brain MRI reportedly showed a large bifrontal lesion, and she was in the process of undergoing expeditious outpatient work-up given the concern for malignancy.

This morning, the patient was found to have difficulty articulating words and was unable to fully close her mouth. She was initially taken to an outside hospital ED, where a maxillofacial CT demonstrated bilateral mandibular dislocation and a diffuse bifrontal hypodensity. The patient was then transferred to our tertiary care ED for jaw reduction.

Currently, the patient denies any headaches, focal weakness, numbness, tingling, or vision changes. She reports no recent trauma and has no personal or family history of connective tissue disorder, malignancy, or inflammatory disease. Her family denies any involuntary movements, tongue biting, or loss of consciousness. She does not take any anticoagulant or antiplatelet medications.