Cognitive impairment in a patient with a normal mini-mental state examination (MMSE)

Abstract

A 75-yr-old man was admitted to the Palhative Care Unit at the Edmonton General Hospital with a squamous-cell carcinoma of the lung metastatic to the liver.He originally presented 1 yr prior to admission with weight loss of 20 lb (9 kg) and vague ~ght~ide chest pain.His chest radiogmph showed a right upper lobe mass and a subsequent bronchoscopy identified a squamous-cell carcinoma.Results of mediastinoscopy were normal.He received p~eope~~ve ~dia~~n, but thoracotomy 2 mo later revealed that the tumor had invaded the superior vena cava and was unresectable.Nine months prior to admission, he received a second radiation treatment.His chief complaint was right arm and shoulder pain, which had been under moderate control with acetaminophen-oxycodone until 1 mo prior to admission.The pain worsened, and computerized tomography (CT) showed encroachment by the tumor into the right brachial plexus, ribs, and mediastinum.