A 30-year-old male diagnosed with schizophrenia was admitted to the hospital after overdosing on his medications. He developed confusion, ataxia, and fever. During the examination, the patient exhibited lead-pipe rigidity and increased tone in his limbs. An ECG showed sinus tachycardia, and further tests including a head CT, lumbar puncture, and septic screen were negative. What medication could potentially improve this patient’s condition?
A 30 year old man is brought to the emergency department in a comatose state. He was discovered by his roommate collapsed on the floor. The roommate reports that the man had been exhibiting strange behavior over the past 24 hours and had been quite agitated and aggressive at times. Upon examination, the man has a Glasgow Coma Scale score of 8 (E 2 V 1 M 5). He has a temperature of 39.4ºC, heart rate of 120/min, blood pressure of 178/89 mmHg, sats of 98% on room air, and respiratory rate of 20/min. His chest is clear and abdomen is soft and non-tender with present bowel sounds. He exhibits globally increased tone in all four limbs.
Reviewing his electronic medical records, the only information available is a recent admission to a psychiatric hospital where he was diagnosed with paranoid schizophrenia.
CT scan of the brain shows no abnormalities.
Lab results show:
– Hemoglobin: 15.4 g/dL
– Platelets: 232 * 10^9/L
– White blood cells: 11.5 * 10^9/L
– Sodium: 143 mmol/L
– Potassium: 4.1 mmol/L
– Urea: 8.1 mmol/L
– Creatinine: 101 µmol/L
– Bilirubin: 14 µmol/L
– ALP: 63 U/L
– ALT: 28 U/L
– Calcium: 2.64 mmol/L
– Albumin: 41 g/L
– Creatine kinase: 21,000 IU/L
– Serum glucose: 6.4 mmol/L
A lumbar puncture was performed with the following results:
– Glucose: 4.9 mmol/L
– Protein: 0.3 g/L
– Culture: no organisms found
– Opening pressure: 21 mmHg
What is the most likely diagnosis?
A 32-year-old man presents to the Emergency department after collapsing at a nightclub. His girlfriend reports that he appeared disoriented and complained of feeling overheated with difficulty swallowing before collapsing while getting water at the bar. He experienced arm and leg twitching for several seconds before regaining consciousness, but was incontinent of urine and drowsy. The patient has a recent diagnosis of schizophrenia and is taking olanzapine. He consumed seven pints of lager and snorted cocaine prior to the episode. On examination, he has a Glasgow coma scale of 8/15, dilated and reactive pupils, and marked muscle rigidity with brisk reflexes bilaterally. His blood pressure is 140/78 mmHg, pulse is 89 beats per minute and regular, and rectal temperature is 39°C. Investigations reveal elevated serum creatinine kinase and myoglobinuria. What is the most likely cause of this patient’s symptoms?
A 45-year-old woman with a history of schizophrenia and multiple hospitalisations presents in a psychiatry ward with a few weeks of feeling unwell and stiffness in her jaws and arms. She has been on haloperidol for symptom control. Her temperature is 38.5°C and BP is 175/85 mmHg. What is the most crucial investigation to conduct?
A 63-year-old woman presents with difficulty lifting her right arm after undergoing a laparoscopic cholecystectomy three weeks ago. She had severe pain in her right shoulder that slowly improved, but now has weakness in shoulder abduction, scapular winging, and sensory loss over the outer aspect of the upper arm on the right. What is the probable diagnosis?
A 56-year-old man presents to the Neurology Department with persistent headaches and nausea, along with recent memory problems. His family is concerned about his forgetfulness. The patient has a history of mild hypertension controlled by diet and worked at a petrochemical plant for 24 years. Routine lab tests were normal, but imaging revealed a hypodense mass with cerebral edema in the left temporal lobe. What clinical signs would have most accurately localized this lesion to the temporal lobe?
A 75-year-old man presents to the Falls Clinic after his third visit to the Emergency Department in the past six months for syncope. His wife is worried because he has been increasingly confused and has had episodes of urinary incontinence. He has a history of hypertension and usually takes indapamide, but stopped on the advice of his General Practitioner. On examination, he has an ataxic gait and evidence of cerebellar dysfunction. He also has a parkinsonian facial appearance with minor tremors on the left side. His blood pressure drops significantly upon standing. There are no murmurs, chest is clear, and there is no ankle swelling. His BMI is 22 kg/m2 and routine bloods are normal. What is the most likely diagnosis?
A 73-year-old man was admitted with a cough productive of green phlegm, shortness of breath and a low-grade fever. Past medical history included Parkinson’s disease for which he was on co-careldopa and hypertension. Chest x-ray showed a right basal consolidation and he was treated for pneumonia with oral antibiotics. As a result of the pneumonia he had a poor appetite and the patient had been refusing to take his medication.
He was given intravenous fluids and encouraged to take his oral antibiotics. Over the next 1-2 days, the nurses noted that he had started to have fever spikes of greater than 38ºC, had developed a tremor and was becoming increasingly rigid, agitated and confused. His blood pressure had also been extremely variable.
What diagnostic test would help confirm the diagnosis?
A 35-year-old man presents to his doctor with recurrent severe pain behind his right eye that has been occurring at night for the past week. He has experienced approximately eight attacks and reports that the pain lasts for about 90 minutes each time. During an attack, his right eye becomes watery and red, and he has vomited several times due to the pain. He is a smoker and drinks alcohol regularly. On examination, he appears flushed and in distress, with a right ptosis and miosis and some right conjunctival injection. His blood pressure is elevated, and his arteries are pulsatile but non-tender. Laboratory tests reveal no significant abnormalities. What is the best treatment to give during an acute episode?
A 32-year-old woman has been referred to the first fit clinic after experiencing a seizure three weeks ago. Her boyfriend witnessed the seizure, which lasted for approximately three minutes and involved violent shaking of her arms and legs. He also noted laboured breathing, blood in her mouth, and incontinence of urine. The day before the seizure, she had consumed one bottle of champagne and felt tired before going to bed. She has a history of asthma and frequent headaches, for which she takes sumatriptan and a salbutamol inhaler as needed. She is a smoker and drinks approximately 20 units of alcohol per week. She works in publishing and holds a driving license.
On examination, her blood pressure is 120/80 mmHg, pulse is 67 beats/minute, and neurological system is normal. Investigations reveal abnormal liver function tests, with elevated gamma GT, alkaline phosphatase, and alanine aminotransferase levels.
What would be the next step in managing this patient?