A 20-year-old farm worker presents with a two-day history of progressive weakness and tingling in all limbs. He had a recent episode of respiratory symptoms that resolved without treatment. On examination, he has decreased muscle strength in all extremities and absent deep tendon reflexes in the legs. Laboratory results show normal blood counts and electrolytes, as well as elevated CSF protein and normal glucose. What is the likely diagnosis?
A 20-year-old farm worker presents with a two-day history of progressive weakness and tingling in all limbs. He had a recent episode of respiratory symptoms that resolved without treatment. On examination, he has decreased muscle strength and absent deep tendon reflexes in his legs. Laboratory results are within normal limits except for slightly elevated plasma urea and CSF protein. What is the most critical parameter to monitor in this patient?
A 29-year-old male presents with progressive weakness in his lower limbs over the course of two weeks, accompanied by feet, hand, and perioral paresthesia. Upon examination, he exhibits reduced reflexes and normal tone in his lower limbs, as well as reduced proprioception in his feet and hands, and proximal weakness in his lower limbs. An MRI of his spine shows no abnormalities.
Further testing reveals a CSF protein level of 2.0g/L, and he tests negative for HIV, Lyme disease, and Epstein-Barr virus. What is the appropriate course of treatment for this patient?
A 28-year-old female patient presents with complaints of frequent migraine attacks that occur throughout her menstrual cycle, unrelated to her periods. Despite taking a combination of paracetamol and ibuprofen, the attacks have not been effectively controlled. The patient is currently taking Cerazette, a progestogen-only pill. What medication would be the most suitable to reduce the frequency of her migraine attacks?
A 50-year-old male presents with ascending weakness. He first noticed that he was tripping over more easily, but now has trouble getting out of a chair. He feels otherwise well. Of note, he did have mild diarrhoea which had completely resolved a week prior to developing this weakness.
On examination, he is haemodynamically stable with a heart rate of 70 beats per minute and a blood pressure of 130/80 mmHg. His respiratory rate is 16 breaths per minute. He has reduced power in ankle plantar and dorsiflexion bilaterally, absent ankle jerks and reduced knee jerks. His plantar responses are downwards.
Which of the following results will most assist you with a diagnosis in this acute presentation?
A 16-year-old girl presents to her GP with weight loss, falls, and poor co-ordination. She reports an eight-month history of unsteadiness of gait and more recently developed slurred speech and upper limb tremors. She denies any changes in bowel habits but mentions increased urinary frequency. She was referred to a cardiologist for recurrent chest pain and palpitations and is awaiting an appointment. On examination, she has scanning speech and gaze-evoked horizontal nystagmus. Bilateral intention tremors with marked past pointing are observed in her upper limbs, and there is pyramidal weakness of both legs with absent knee and ankle reflexes and extensor plantar responses. She has a high steppage gait and positive Romberg’s test. Investigations reveal an axonal sensory motor neuropathy, left ventricular hypertrophy, and elevated fasting plasma glucose. Given these findings, what is the likely diagnosis?
A 33-year-old female patient presents with a four-week history of bifrontal headache, decreasing visual acuity, and walking difficulties. She has no significant medical history. On examination of cranial nerves, there is bilateral VIth nerve palsy, and fundoscopy reveals bilateral papilloedema. Visual acuity is reduced, and gait is ataxic. Routine blood count reveals an elevated platelet count of 867 ×109/L. Haemoglobin, haematocrit, white cell count, iron store, and inflammatory markers are all normal. MRI brain shows cerebral venous sinus thrombosis with a small cerebellar haemorrhage. What is the best next step in managing this patient?
A 25-year-old man is referred by his family doctor for neurological assessment. He comes from a family who rarely seek medical attention. His brother has had hearing difficulties for the past 5 years and uses a hearing aid. The patient has been experiencing increasing unsteadiness and slurred speech over the past 6 months, but is still performing well at work.
During the examination, both optic discs appear pale and there is fine nystagmus. The patient’s speech is dysarthric and there is bilateral intention tremor. There is also muscle wasting in the distal limbs, absent tendon reflexes, and extensor plantar responses. Romberg’s test is positive. The patient’s blood pressure is 110/70 mmHg with no orthostatic hypotension.
What is the most probable diagnosis?
A 25-year-old investment banking intern presents to the urgent care centre with a complaint of progressive unsteadiness on walking over the past 6 months. The patient has no significant medical history except for type 2 diabetes, which is diet controlled and was diagnosed a year ago. There is no family history of any diseases. The patient reports working long hours for the past 2 years and experiencing high levels of stress at work. The work culture involves binge-drinking to bond with the team after work. The patient reports drinking up to 30 units of alcohol a week. Over the past 3 months, the patient has noticed a lack of articulation with speech, which was assumed to be secondary to alcohol. On examination, the cardiovascular, respiratory, and abdominal systems are unremarkable. The finger-nose test is impaired bilaterally, and the patient is unable to tandem walk. There is no neck stiffness or headache, and the patient has a full range of eye movements. The patient has absent reflexes in the lower limbs and upgoing plantars bilaterally. What investigation will provide the definitive diagnosis?
A 50-year-old accountant visits his doctor after his family expresses concerns about his behavior. He was discovered to have misappropriated funds at work by purchasing items online. He made inappropriate comments to his friends, and his job performance deteriorated to the point where he was eventually fired. His wife reported that he would simply sit and watch TV and lose interest in his hobbies. He began to snack excessively and gained a pound in weight in a week. On formal testing, he scored 27/30 on the MMSE, but he failed tests on verbal fluency. What is the most probable diagnosis?