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Had a repeat magnetic resonance imaging (MRI) of the head. She had a lesion seen in the right frontal lobe on previous computed tomography (CT) and MRI scanning. This lesion has not changed at all over time. I have reviewed this with our neuroradiologist here and it seems somewhat unlikely that this is a low-grade glioma.

We have really pursued quite a great deal in the way of workup for this very unfortunate woman’s dementia. One thing that we have not done was a lumbar puncture, and I think that this is probably quite reasonable, given the fact that we have not found a treatable cause for her memory loss and are really more or less presuming that the underlying disease is Alzheimer disease.

I would suggest that a lumbar puncture be done, and that spinal fluid sent for Venereal Disease Research Laboratory (VDRL), Acid-Fast bacillus/bacilli (AFB) stain and culture, fungal stain and culture, cryptococcal antigen, bacterial culture, glucose, protein, and cell count.

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