A 70-year-old man presents to the emergency department with sudden onset weakness. He has a medical history of hypertension and atrial fibrillation and is currently taking amlodipine, bisoprolol and apixaban. Upon examination, he has 4/5 power in his right upper and lower limbs, left eye deviation, left-sided ptosis, and normal pupillary responses. A CT head scan shows no abnormalities. Which cerebral artery is most likely affected in this case?
A 45-year-old man with chronic alcohol abuse is brought to the Emergency department by the police after being found wandering the streets at 3 am. He has a history of multiple admissions related to alcohol abuse.
Upon examination, he appears dishevelled, confused, and has a strong smell of alcohol. He is disoriented in time and place, with a mini-mental score of 16/30. His blood pressure is 138/90 mmHg, and he is apyrexial. He has bilateral sixth nerve palsies, gaze-evoked nystagmus, and gait ataxia.
What is the appropriate treatment for this patient?
An 80-year-old man is admitted to the acute medical unit 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.
The following investigations are ordered:
CT head Blood found in the sulci, fissures, basal cisterns, and ventricles.
What would be the most suitable course of action now?
A 72-year-old man is brought to the emergency department after being found unresponsive in his armchair by his wife. Prior to this, he had been feeling well. On examination, bilateral 1 mm pupils are noted and his Glasgow coma score is 4 (M2, E1, V1). The patient has a medical history of hypertension, hypercholesterolemia, and osteoarthritis, and is currently taking codeine, paracetamol, ramipril, and atorvastatin. Despite administering 400 micrograms of naloxone, there is no change in GCS or pupil size. What is the most likely diagnosis?
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 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 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?
A 16-year-old Caucasian male with no prior medical history presents with his first episode of sudden onset left leg weakness and numbness on his anterior left thigh, which has persisted for 5 days. Upon examination, it is noted that he has 3/5 weakness on flexion of his left hip and loss of sensation to light touch, pain, and temperature on his anterior left thigh in the sensory nerve root L1 distribution. A contrast MRI scan of the patient’s spine reveals a hyperintense T2 signal partially within the left side of the cord at the L1, with corresponding enhancement with gadolinium. No masses were observed. Further imaging of the brain is pending. What is the most probable diagnosis at this time?
A 75-year-old male visits the PD clinic with a complaint of uncontrollable jerking and flailing movements in his arm, which he finds embarrassing and disabling. He reports minimal issues with ‘off’ periods and few other PD symptoms. His medical history includes PD diagnosed 6 years ago and type 2 diabetes. He is currently taking Sinemet 250 for Parkinson’s disease 5 times a day and metformin 500mg TDS, with no changes in Sinemet dosage for the past 18 months. What is the most appropriate course of action for management?