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Factitious lymphedema of the hand: a diagnostic challenge.

A case of factitious lymphedema of the hand is presented. Attention is drawn to this entity and its differential diagnosis. Delayed detection in our case resulted in prolonged and costly hospitalization with some loss of hand function. Treatment should be left to those skilled in psychotherapy.

Adult↗

Alzheimer's disease: making the diagnosis.

Alzheimer's disease accounts for about 60 percent of dementia cases. Misdiagnosis of the treatable dementias can have devastating results. Pseudodementia accompanying major depression and chronic cognitive dysfunction due to psychoactive drugs are among the most commonly missed diagnoses. Although cortical atrophy is regularly found on computed tomographic scans in Alzheimer's disease, it is not necessarily diagnostic. A relatively distinct onset of cognitive impairment is not characteristic of Alzheimer's disease.

Aged↗

[Oral leukoedema--sequela of an artifact].

A 23-year-old white female with a history of psychological instability presented with burning, adhesive, white plaques of the buccal mucosa. She had been unsuccessfully treated for 1.5 years with topical retinoids as well as topical and systemic corticosteroids. The differential diagnoses included leukoplakia, cheek biting and lichen planus. Clinical and histopathological examinations suggested the diagnosis of severe oral leukoedema. Careful history and clandestine surveillance of the patient finally revealed the lesions to be due to a caustic (over-the-counter product for the treatment of corns), which the patient regularly applied to her buccal mucosa.

Adult↗

[Simulated alcoholic delirium].

Of 200 diagnosed cases of alcoholic delirium 5 (= 2.5%) involved, from the differential diagnostic viewpoint, simulation of alcoholic delirium with all the symptoms involved. The symptoms of the simulation case are compared with the acute symptoms, and points in common to all simulation cases are presented: Definite alcoholic anamnesis, wide experience of treatment for alcohol abuse, dynamics of a pronounced purposeful action when social complications are imminent and course of the symptoms when the interview turns to simulation. In connection with therapy, special attention is drawn to Distraneurin treatment, which is not indicated in such cases.

Adult↗