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2022-05-30 08:52:01 A 61-year-old man comes to the office due to a painful rash on his face for the past 3 days. The patient has no other medical conditions and takes no medications. He is a retired schoolteacher and lives with his wife. Skin examination findings are shown in the exhibit. The remainder of the physical examination shows no abnormalities. Open / Comment

2022-04-30 07:49:01 Open / Comment

2022-04-30 07:48:01 A 65-year-old man comes to the emergency department due to sudden-onset headache. The patient has had no recent falls or head trauma. Medical history includes hypertension and lung adenocarcinoma with abdominal metastasis. Initial noncontrast CT scan of the head reveals a small temporal lobe hemorrhage.
Over the next 24 hours, the patient becomes progressively obtunded and develops generalized tonic-clonic seizures. Blood pressure is 190/96 mm Hg, pulse is 38/min, and respirations are 1 O/min with brief episodes of apnea. A repeat noncontrast CT scan of the head reveals acute hemorrhage expansion with brain herniation. Open / Comment

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Open / Comment

2022-04-29 21:47:01 Educational objective: Essential tremor most often presents as a tremor of the hands that is suppressed at rest, exacerbated by outstretched arms, and more pronounced during goal-directed movements. It is often hereditary (autosomal dominant) and can be associated with a head tremor, but it is not associated with other neurologic symptoms. Open / Comment

2022-04-29 07:47:01 Open / Comment

2022-04-29 07:46:01 A 44-year-old man comes to the office due to hand tremors. The patient first noticed the tremor 2 years ago, and it has gradually worsened. He feels well most of the time, but his hands shake uncontrollably with activities such as pouring drinks or writing notes. The symptoms are most pronounced during stressful situations such as office meetings, and he keeps his hands tightly squeezed together or hidden below the table. He has had no arm stiffness, leg symptoms, or difficulty walking, but his wife has noticed that the patient occasionally keeps nodding his head while talking. Physical examination shows obvious tremors of outstretched hands that worsen during finger-nose testing. Open / Comment

2022-04-28 21:46:01 Educational objective: Arteriovenous malformations occur when an artery directly anastomoses with veins without an interposed capillary bed. They may result in spontaneous intracerebral hemorrhage or seizures, or they may be discovered incidentally when brain imaging is obtained for another reason. Open / Comment

2022-04-28 07:45:19 Open / Comment

2022-04-28 07:44:01 A 17-year-old right-handed boy is brought to the emergency department due to brief loss of consciousness after colliding with another player during a football game. The patient reports "fogginess" but has had no headache, vomiting, focal weakness or numbness, or seizures. He has no other medical conditions and takes no medications. Vital signs are within normal limits. On physical examination, the patient demonstrates retrograde amnesia about the game but no focal neurologic deficits. CT angiography of the head reveals no skull fractures or intracranial bleeding, but a small lesion in the left temporoparietal region composed of abnormal vascular channels is noted and is shown in the exhibit. Open / Comment