An 80-year-old man comes to the emergency department complaining of slurred speech and right-sided facial drooping that occurred after lunch. He mentions that the symptoms mostly resolved within ten minutes of onset but took another five minutes to fully disappear.
Upon examination, there are no remaining signs of dysphasia or facial droop, and his neurological exam is normal.
Which imaging technique would be the best choice for this patient?
A 30-year-old woman presents to the Emergency department with sudden onset left-sided arm and leg weakness. She had a generalised headache prior to the onset of weakness, along with an area of anaesthesia over the right cheek. She also experienced blurring of vision, but denied any diplopia, visual aura or restriction of visual fields.
Her medical history includes menorrhagia and a laparoscopy for intermittent abdominal cramps. She is a smoker and admits to a cocaine habit. She drinks 16 units of alcohol per week, lives with her 4-year-old daughter and does occasional temporary work.
On examination, she appears well and cooperative. Her blood pressure is 135/67 mmHg, pulse is 78/min and regular, and heart sounds are normal. There are no carotid bruits. On cranial nerve examination, she complains of an area of anaesthesia over the right cheek. Fundoscopy, visual fields, pupillary reflexes, and facial musculature are all normal.
Upper limb examination reveals normal tone bilaterally with brisk symmetrical reflexes. Power is normal in the right arm, but she is unable to move the left arm. Sensation appears normal. Lower limb examination reveals left-sided rigidity with suppressed knee and ankle reflexes, mute plantar response, and a power of 0/5.
A contrast-enhanced CT scan of the brain is normal. A lumbar puncture is performed and yields the following data:
– Opening pressure 13 cmH2O (5 – 18)
– CSF protein 0.34 g/L (0.15 – 0.45)
– CSF white cell count 4 cells per ml (<5)
– CSF red cell count 3 cells per ml (<5)
– CSF oligoclonal bands Positive –
– Serum oligoclonal bands Positive –
What is the most likely diagnosis for this patient?
A 75 year old male presents with a low frequency irregular tremor of the right hand and ataxia. The tremor is present at rest and when he holds his arms outstretched. The frequency of the tremor ranges from 3-4 Hz and is enhanced with posture and aggravated with movement. On neurological examination patient was found to have an ataxic gait with mild right arm weakness (power 4/5). He had a past medical history of type 2 diabetes mellitus, hypertension and previous stroke. What is the most likely diagnosis for his tremor?
A 45 year-old man presents to the general medical clinic with a one year history of generalised weakness. He mentions his father suffered from the same symptoms, although from a later age.
His past medical history includes type two diabetes mellitus (diet controlled) and eczema.
On examination he has male pattern balding and an expressionless face. You note a diminished left red reflex, with a normal cranial nerve examination. He has symmetrically reduced reflexes throughout, with mild reduced power distally in both upper and lower limbs.
Hb 140 g/l
Platelets 200 * 109/l
WBC 8 * 109/l
CK 70 IU/L (reference range 60- 174 IU/L)
What is the most likely diagnosis?
A 23-year-old male patient is brought to the Emergency Department with a stab wound on the left side of his torso. The knife was lodged 2-3 cm deep and he underwent surgery shortly after admission. He is currently recuperating on the General Surgical Ward when he reports to the nursing staff that he is experiencing difficulty extending his knee and has numbness from the inner side of his knee to the inner side of his foot. Additionally, his knee reflex is absent on that side. Which nerve root is most likely to have been affected?
A 69-year-old man is admitted to the ward with an exacerbation of severe abdominal pain. He describes it as a burning tight band-like pain. The patient has a medical history of metastatic prostate cancer and is currently taking morphine modified release (100mg, twice daily), duloxetine (60mg, twice daily), and pregabalin (200mg, three times per day). Although the pain initially responded well to the analgesics, it has progressively worsened over the past few weeks and culminated in a severe attack of pain today.
After consulting with the palliative care consultant, you decide to initiate an NMDA receptor antagonist. What medication will you commence?
A 63-year-old woman comes to the Neurology Clinic complaining of pulsatile tinnitus, dysarthria, and difficulty in eating and swallowing food for the past 8 months. She also experiences episodes of severe sweating and palpitations that resolve on their own. She had no previous health issues. Upon examination, she displays right-sided X, XI, and XII nerve lesions, as evidenced by a depressed cough reflex, sternocleidomastoid weakness, and tongue wasting. The rest of the neurological examination is normal. What is the most probable diagnosis?
A 35-year-old woman comes to the clinic with her 65-year-old mother, who is taking L-dopa for Parkinson’s disease. She expresses concern about her own risk of developing the condition, as her grandmother also had Parkinson’s.
Which of the following symptoms is most commonly associated with early onset Parkinson’s?
A 28-year-old man has been experiencing a gradual onset of bilateral leg weakness for the past 18 months, which has progressed to the point where he now requires crutches to walk. He also experiences intermittent urinary incontinence and falls frequently in the dark due to poor balance. He denies any previous symptoms and has no significant medical history. He works as an accountant and has a history of traveling to the Caribbean, Japan, and Africa in his early 20s. During his travels, he admits to occasional intravenous drug use and getting a tattoo. He also reports having casual sexual contact with sex workers without using barrier contraception. On examination, he has hyperreflexia bilaterally in the legs with upgoing plantar responses and loss of vibration and joint position sense in the legs. His knee and plantar extensors are 3/5 power, while his flexors are 4/5 power. He has a stomping gait. Routine blood tests and HIV screening are unremarkable, but MRI brain and whole spine reveal areas of demyelination in the lumbar spine. What test would you perform to confirm the suspected cause of his symptoms?
A 67-year-old man presents to the emergency department after experiencing a sudden loss of consciousness. He reports having a severe headache earlier in the day, which started at the back of his head and quickly escalated to a 10/10 level of pain.
Upon conducting the following investigations:
– CT head: Blood found in the sulci, fissures, basal cisterns, and ventricles
– Cerebral CT angiogram: Evidence of a ruptured aneurysm in the posterior cerebral artery
What would be the most appropriate initial management for this patient?