A 73-year-old man presents to clinic following a recent cerebral infarct. He has a history of heavy smoking and hypertension, managed with ramipril. Despite some left-sided motor weakness and spasticity affecting his hand, he is able to independently perform daily activities. A carotid Doppler revealed 90% stenosis of the right internal carotid. He is currently taking clopidogrel. What is the most suitable course of treatment for this patient?
A 42-year-old male comes to your headache clinic complaining of daily left-sided headaches for the past 8 months. The pain is located in the frontal and retroorbital area and he reports no pain-free periods. The headaches are moderate in severity, typically 5/10, but occasionally worsen to 9/10. He also experiences left-sided conjunctival injection and lacrimation during the headaches. What diagnostic tool would be most helpful in determining a diagnosis?
A 82-year-old woman presents with poor mobility and lethargy. Her husband called for an ambulance when he had difficulty waking her up in the morning. She would briefly open her eyes in response to his voice before falling back asleep. She typically uses a Zimmer frame to walk and had fallen the week before being admitted. Her medical history includes hypertension and diabetes.
During examination, her Glasgow coma scale was reduced to 13/15 and both planters were upgoing. An urgent CT head scan was ordered, revealing evidence of bilateral subdural hematomas.
Which vessel is affected in this case?
A 35-year-old male patient arrives at the Emergency department with a medical history of epilepsy. He reports experiencing jerking movements starting from the left corner of his mouth, which then spread to his left thumb and index finger. Eventually, his entire left side began to jerk, but the movements subsided after ten minutes. Following the episode, he experienced weakness on his left side for several hours. Despite this, he maintained full consciousness throughout the event. What is the probable diagnosis?
A house officer is asked to review a patient on her ward as the nurses are concerned about the patient’s speech. The house officer reports that the patient has unilateral weakness of her right face, arm and leg, dysphasia and a visual field defect. She reports that reflexes are brisk on the right and that the tone of the limbs is increased. There is no dysdiadochokinesia on the left, but she is unable to assess on the right arm. The patient’s heart rate is 65, blood pressure 198/100 mmHg and respiratory rate 14. Jugular venous pressure is 2 cm above the sternal notch. Pupils react to light and are consensual. The patient’s family is present who report that the symptoms were sudden in onset. The family is unsure about past medical history, but a list of medications includes warfarin, bendroflumethiazide, ramipril, atorvastatin and allopurinol. A CT head reveals a cerebral infarct.
How would this stroke be classified?
A 27-year-old female from the travelling community presents to A&E after experiencing a seizure. According to her family, she had been suffering from headaches for the past 24 hours and had been feverish and vomiting this morning. Her partner reports that she was unwell with a fever and whole body rash that resolved on its own about a month ago. She has no significant medical history.
During the examination, she appears drowsy and has a left-sided hemiparesis with bilateral nystagmus. Papiloedema is observed during fundoscopy, but there are no skin rashes.
What is the most likely underlying diagnosis?
An 82-year-old man presents to the Emergency Department after experiencing slurred speech and facial drooping for an hour. He has a medical history of type II diabetes, hypertension, and hypercholesterolemia. CT scan shows ischaemia in the right middle cerebral artery (MCA) territory, and his NIHSS score is 14. He receives alteplase therapy and undergoes endovascular thrombectomy in the Interventional Radiology Suite. However, 12 hours later, the nurse observes a decrease in his GCS score, and a repeat CT scan reveals haemorrhagic transformation (HT) in the MCA territory. What is the most significant risk factor for HT in ischaemic stroke?
A 35-year-old woman has just received a diagnosis of Becker’s muscular dystrophy (BMD). As her healthcare provider, what clinical advice would you give her about her condition?
A 55-year-old unemployed man presented with a 7-month history of progressive speech difficulty. He had appeared depressed over the same period after losing two jobs in the last year. His wife commented that he had lost all motivation and spent most of the day at home. His appetite had changed and he had become very fond of sweet foods, with his weight increasing by 2 stones in the last year. Higher mental function testing revealed problems with naming and in tasks requiring planning.
Examination of the cranial nerves and limbs was normal.
What is the most likely diagnosis?
A 32-year-old man presents to the Psychiatry Hospital with a 4-month history of insomnia, weight loss, depression, forgetfulness, and pins-and-needles sensation in his limbs. He was prescribed amitriptyline, but after 8 weeks, he began experiencing increased forgetfulness, unsteadiness, and intermittent incontinence. A medical registrar was consulted and found the patient disorientated to place and person, with myoclonic jerks, restricted upward gaze, limb and gait ataxia, and flexor plantar reflexes. A CT scan of the head was normal, but an EEG showed diffuse slowing. Further investigations revealed a positive anti-thyroid peroxidase antibody and elevated TSH levels. What is the most likely diagnosis?