Neurology collections 2020

2022-03-20 21:48:57 Open / Comment

2022-03-20 21:47:37 A 50-year-old woman is brought to the emergency department after suddenly experiencing right upper and lower extremity weakness while jogging on a treadmill. Her weakness gradually worsened over the next hour, and she had severe headache, nausea, and vomiting. The patient has a history of chronic hypertension but stopped taking antihypertensives several months ago. She does not use tobacco but drinks 1 or 2 glasses of wine on weekends. Blood pressure is 230/112 mm Hg and pulse is 76/min and regular. On physical examination, the patient is stuporous and responds to painful stimuli only. There is right hemiplegia, right hemisensory loss, and leftward deviation of the eyes. Which of the following is the most likely diagnosis? Open / Comment

2022-03-17 23:54:59 Simple febrile seizures are typically benign and occur in children age 6 months to 5 years. They are generalized, last <15 minutes, and do not recur within 24 hours. Diagnostic testing is unnecessary, and management is with supportive care (eg, antipyretics) and reassurance. Open / Comment

2022-03-17 23:20:43 Open / Comment

2022-03-17 23:17:31 A 2-year-old boy is brought to the emergency department by ambulance due to convulsions. This morning, the patient was sitting on the sofa at home when he suddenly developed rhythmic movements of both arms and legs that lasted about 3 minutes. He was not responsive during the event. Emergency personnel report that the child was sleepy and seemed confused when they arrived. The patient has had rhinorrhea for the past 2 days and fever since this morning. He has had no cough, vomiting, or diarrhea. The patient has no chronic medical conditions, and immunizations are current. His uncle has epilepsy. Temperature is 39.2 C (102.6 F). Physical examination shows an alert and playful toddler. Bilateral conjunctivae are clear, and clear rhinorrhea is present. The neck is supple with full range of motion. Mucous membranes are moist, and capillary refill is <2 seconds. The remainder of the examination is normal. After treating the fever with acetaminophen, which of the following is the best next step in management of this patient? Open / Comment

2022-03-17 23:17:25 HIV infection can cause dementia that progresses over a longer time period than progressive multifocal
leukoencephalopathy (PML). Symptoms are of:
Confusion
Depression
Reduced concentration
Behavioural changes
Psychosis
Speech and balance problems, as well as
Muscle weakness.
Patients with cryptococcal meningitis present with headache, fever, vomiting and few neurological signs.
PML can present at any CD4 count with ataxia, behavioural changes and focal neurological signs, often
progressing over a period of months to paresis or even coma.
Toxoplasmosis presents with headache, fever and seizures. It has a typical CT head scan with ring enhancing
lesions.
This patient's symptoms may be compatible with schizophrenia, however given his HIV status and neurology
HIV dementia is more likely. Open / Comment

2022-03-17 22:27:25 Open / Comment

2022-03-17 22:26:28 A 43-year-old gentleman has been brought to the Emergency department by his partner.
He was diagnosed with HIV infection 10 years ago and his CD4 count has been maintained on triple therapy.
He has recently been dismissed from work for poor performance. He has lost interest in cooking and socialising
over the past 10 months. There has been a slurring in his speech. His partner feels he has been more
aggressive and withdrawn, however in the past few days he has started to have hallucinations.
What is the likely diagnosis? Open / Comment

2022-03-10 23:20:57 Open / Comment

2022-03-10 23:19:30 A 35-year-old man has wrist drop of his right hand. Examination reveals a small area of sensory loss on the dorsum of the hand. Which of the following nerves is likely to be involved? Open / Comment