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A 58-year-old man presented to our neurology clinic with a history of spatial disorientation and frequent, throbbing, headaches typically of 30-minute duration and associated with nausea, vomiting, and blurred vision. His medical history was significant for a mild head injury and occasional alcohol intake. His father and sister had long histories of headaches. Over the last 3 years, his wife had noticed cognitive decline, apathy, and behavioral disorders; once he left his house undressed and passed stools into inappropriate places.
The patient's general physical examination was normal. Blood pressure was 130/80 mm Hg, pulse rate was 80 beats per minute, respiratory rate was 16 breaths per minute, and temperature was 36.7°C. Neurologic examin…