You are requested to evaluate a 55 year-old woman who has arrived urgently at the ophthalmology clinic complaining of worsening vision. Upon inquiry, she reports a sudden loss of clarity in the temporal field of her left eye. Her medical history is significant for hypertension and type 2 diabetes mellitus.
What is the probable diagnosis?
An 80-year-old man has been admitted to the Coronary Care Unit late in the evening. Past medical history includes diabetes, glaucoma, hypertension, angina, transient ischaemic attacks and peripheral vascular disease.He had collapsed at home and, on arrival to hospital, was in complete heart block. After a few attempts, a transvenous pacing wire was inserted in the right internal jugular vein.During the night shift, the ward staff become concerned as his condition has deteriorated. He is complaining of a severe left frontal headache with associated nausea and vomiting. He also has blurring of vision in his left eye and has noted some flecks of bright red blood in his vomit.His temperature is 36.9 oC, pulse 90/min regular, blood pressure 180/94 mmHg, respiratory rate 22/min.Examination reveals a fixed dilated pupil on the left side. There is no other focal neurology. His abdomen is soft.What medication would be beneficial for this patient?
A 25-year-old female presents with a history of headaches for the past eight weeks, which have worsened over the last week. She reports a constant frontal headache that is not relieved by paracetamol. The headaches have been present in the morning and throughout the day recently. Additionally, she has gained over 7 kg in weight in the last six months.
During examination, the patient appears tearful and has a BMI of 32 kg/m2. There is no nuchal rigidity, and neurological examination is normal except for bilateral optic disc swelling on fundal examination. Her blood pressure is 122/88 mmHg, and her temperature is 37°C. An MRI scan of her brain is normal, and LP reveals an opening pressure of 30 cm H2O but normal CSF analysis.
If the patient had progressive visual loss, what treatment would you offer?
A man in his forties presents with sudden loss of vision in one eye. Upon examination, he exhibits a relative afferent pupillary defect. Fundoscopy reveals the following image:
What is the most probable diagnosis?
A 56-year-old female presents to her GP with a sudden decrease in vision in her left eye. She has a medical history of type 2 diabetes mellitus and hypertension. During fundoscopy, the GP observes that the left optic fundus appears pale, but is unable to see it clearly. What is the probable diagnosis?
A 68-year-old male presents to your neurology clinic with his wife, complaining of worsening vision in his left eye over the past 4 months. Despite being hesitant to seek medical help, he has finally decided to attend due to a number of factors.
In addition to his vision problems, he reports a constant and worsening headache over the past 3 months, which is worse at night and with coughing. He has also experienced nausea and vomiting on multiple occasions, with at least two instances waking him from sleep. His wife has noticed a significant change in his personality, with increased emotional outbursts and occasional aggression, which she attributes to his struggles with his symptoms. Prior to these symptoms, he had no past medical or drug history and was generally healthy.
During the examination, you observe a left relative afferent pupillary defect with equally sized pupils. The patient’s left eye has a visual acuity of 6/60, while the right eye has a visual acuity of 6/9. Testing of colour vision with Ishihara plates shows 0/17 on the left and 17/17 on the right. A central scotoma is present in the left eye. Fundoscopy of the left eye reveals a pale optic disc with poor vasculature, while the right eye appears swollen. The patient demonstrates a full range of painless eye movements, and the remaining examination of the cranial nerves, upper and lower limbs are unremarkable. Drops of blood are unremarkable, and an MRI head is pending.
What is the most likely diagnosis?
A 57-year-old male presents with sudden onset visual disturbance in his right eye that has been ongoing for 3 days. He reports it to be his first episode with no previous history of visual problems. His medical history includes type 2 diabetes mellitus, hypertension, and raised BMI. He is an active smoker of 40 pack years.
Upon examination, a right relative afferent pupillary defect is detected. Pupils were equal in size. A visual field defect is demonstrated in the inferior nasal field of the right eye without a precise quadrantanopia or altitudinal pattern. Temporal arteries are non-tender and not thickened. Visual acuity on Snellen chart in left eye was 6/6, 6/18 in right. Colour vision on Ishihara plates were 17/17 on left, 5/17 on right. Fundoscopy is unremarkable. Examination of the upper and lower limbs are unremarkable, no language deficits are noted. Auscultation revealed normal heart sounds and no bruits.
His blood tests are as follows:
Hb 154 g/l
Platelets 190 * 109/l
WBC 7.8 * 109/l
ESR 5 mm/hr
Na+ 141 mmol/l
K+ 3.9 mmol/l
Urea 5.6 mmol/l
Creatinine 80 µmol/l
What is the most likely diagnosis?
A 65-year-old male presents with a 4-month history of left foot drop. He reports having to lift his thighs higher than usual to accommodate this issue. During examination, he displays a high stepping gait. All movements have normal power except for left ankle dorsiflexion (2/5) and eversion (2/5). Ankle inversion is intact (5/5), ankle jerks are present, and plantars are downgoing. He also reports reduced sensation on the dorsum of his foot. What is the most probable diagnosis?
A 30-year-old man presents to the Emergency Department after experiencing three consecutive tonic-clonic seizures. He was administered 10mg of rectal diazepam and has since stabilized.
According to his girlfriend, he has been generally healthy except for recurrent sinusitis. However, over the past month, he has been complaining of worsening headaches and was prescribed antibiotics by his GP.
He does not take any regular medication, but his partner reports that they occasionally use ecstasy while out at night.
Upon examination, he appears drowsy with a Glasgow Coma Scale (GCS) of 12. His temperature is 38.8 degrees Celsius, his pulse is regular at 57 bpm, his blood pressure is 150/90 mmHg, and his oxygen saturation is 97% on 15L oxygen via a non-rebreather mask.
Cardiovascular examination reveals normal heart sounds and a capillary refill time of 3 seconds. His calves are soft and non-tender, his chest is clear with no signs of consolidation, and his abdominal examination is unremarkable.
Neurological examination is challenging due to the patient’s low GCS, but no focal abnormality is detected. When attempting to passively flex his neck, he becomes agitated and visibly uncomfortable. His pupils are equal and reactive to light, and fundoscopy reveals bilateral oedematous optic discs.
His blood test results are as follows:
– Na+ 130 mmol/L
– K+ 3.9 mmol/L
– Urea 5 mmol/L
– Creatinine 80 µmol/L
– Hb 160 g/L
– WBC 25.0×10^9/L
– Neutrophils 91%
– LFTs Normal
– CRP 90 mg/L
Based on the information provided, what is the most likely diagnosis?
A 67-year-old man presents with left arm pain that starts in the shoulder and spreads to the ring and little fingers. The pain has been getting worse over the past four weeks, making it difficult for him to sleep at night. Despite taking co-codamol prescribed by his GP, he has not experienced any relief.
The patient has a history of smoking for 40 pack years, hypertension, and a heart attack five years ago. He reports losing 2 stone in weight over the last three months, despite increasing his food intake. He also has a productive cough with occasional streaks of blood.
During the examination, the patient is able to move his left shoulder, elbow, and wrist without any tenderness, but he experiences pain when not moving. He has some weakness in his left biceps, with a diminished reflex and reduced sensation in the fourth and fifth fingers when touched lightly. The limb has normal pulses and capillary refill time, with no swelling. The patient has crepitations in the left upper zone and clubbing.
The patient’s blood test results show a low hemoglobin level, elevated CRP, and consolidation seen in the left upper zone on chest x-ray. Based on these findings, what is the likely diagnosis?