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A 52 years old man presents with some difficulty driving at night and reports not seeing cars coming from the sides. He also describes progressive loss of libido and inability to obtain and maintain an erection, which started about 2 years ago. He has gained about 5 kg (11 lbs) in weight over the 2 to 3 years and reports increased fatigue that makes him unable to do the same jobs that he used to do a year ago. On physical examination, the patient has a BMI 35 and abnormal visual fields with bitemporal hemianopia. What potential sequelae do you need to be concerned about?

December 26, 2020 7:57 am Published by

Pituitary apoplexy (hemorrhage), hormonal disease of hyperpituitarism, meningitis and neurologic deficits

A 52 years old man presents with some difficulty driving at night and reports not seeing cars coming from the sides. He also describes progressive loss of libido and inability to obtain and maintain an erection, which started about 2 years ago. He has gained about 5 kg (11 lbs) in weight over the 2 to 3 years and reports increased fatigue that makes him unable to do the same jobs that he used to do a year ago. On physical examination, the patient has a BMI 35 and abnormal visual fields with bitemporal hemianopia. What are the most important differential diagnoses?

December 26, 2020 7:55 am Published by

Of the relevant differential diagnoses, it is important to rule out parasellar tumors, pituitary hyperplasia, meningioma and vascular aneurysm.

A 52 years old man presents with some difficulty driving at night and reports not seeing cars coming from the sides. He also describes progressive loss of libido and inability to obtain and maintain an erection, which started about 2 years ago. He has gained about 5 kg (11 lbs) in weight over the 2 to 3 years and reports increased fatigue that makes him unable to do the same jobs that he used to do a year ago. On physical examination, the patient has a BMI 35 and abnormal visual fields with bitemporal hemianopia. What is the most likely diagnosis?

December 26, 2020 7:54 am Published by

Pituitary adenoma

A 75 years old man presents with problems walking that have developed over the past 2 months, consisting of slow gait, imbalance (especially on turning), short stride length, and gait initiation failure. He reports urinary frequency, occasional urge incontinence, headaches, and some memory loss. On examination, his symptoms are symmetric and much more prominent in the lower half of the body, with relative sparing of hand function, and normal facial expressiveness. Fundoscopic examination reveals bilateral papilledema. What potential sequelae do you need to be concerned about?

December 26, 2020 7:53 am Published by

Stroke, subdural hematoma and brain stem compression (due to nuchal and/ or cerebellar tonsil herniation)

A 75 years old man presents with problems walking that have developed over the past 2 months, consisting of slow gait, imbalance (especially on turning), short stride length, and gait initiation failure. He reports urinary frequency, occasional urge incontinence, headaches, and some memory loss. On examination, his symptoms are symmetric and much more prominent in the lower half of the body, with relative sparing of hand function, and normal facial expressiveness. Fundoscopic examination reveals bilateral papilledema. What are the most important differential diagnoses?

December 26, 2020 7:50 am Published by

Of the relevant differential diagnoses, it is important to rule out space occupying lesion (tumor, cysts, cerebral abscess), subarachnoid hemorrhage... View Article

A 75 years old man presents with problems walking that have developed over the past 2 months, consisting of slow gait, imbalance (especially on turning), short stride length, and gait initiation failure. He reports urinary frequency, occasional urge incontinence, headaches, and some memory loss. On examination, his symptoms are symmetric and much more prominent in the lower half of the body, with relative sparing of hand function, and normal facial expressiveness. Fundoscopic examination reveals bilateral papilledema. What is the most likely diagnosis?

December 26, 2020 7:50 am Published by

Hydrocephalus

A 69 years old man presents with a one year history of mild slowness and loss of dexterity. His handwriting has become smaller, and his wife feels his face is less expressive and his voice is softer. Over the last few months he has developed a subtle tremor in the right hand, noted while watching television. His symptoms developed insidiously but have mildly progressed. He has no other medical history, but he has noted some mild depression and constipation over the last 2 years. His examination demonstrates hypophonia, masked facies, decreased blink rate and rigidity. An intermittent right blink rate rigidity. An intermittent right upper extremity resting tremor is noted while he is walking. What potential sequelae do you need to be concerned about?

December 26, 2020 7:48 am Published by

Permanent neurological deficit, dementia and depression

A 69 years old man presents with a one year history of mild slowness and loss of dexterity. His handwriting has become smaller, and his wife feels his face is less expressive and his voice is softer. Over the last few months he has developed a subtle tremor in the right hand, noted while watching television. His symptoms developed insidiously but have mildly progressed. He has no other medical history, but he has noted some mild depression and constipation over the last 2 years. His examination demonstrates hypophonia, masked facies, decreased blink rate and rigidity. An intermittent right blink rate rigidity. An intermittent right upper extremity resting tremor is noted while he is walking. What are the most important differential diagnoses?

December 26, 2020 7:48 am Published by

Of the relevant differential diagnoses, it is important to rule out brain tumor, Wilson’s disease and hydrocephalus.

A 69 years old man presents with a one year history of mild slowness and loss of dexterity. His handwriting has become smaller, and his wife feels his face is less expressive and his voice is softer. Over the last few months he has developed a subtle tremor in the right hand, noted while watching television. His symptoms developed insidiously but have mildly progressed. He has no other medical history, but he has noted some mild depression and constipation over the last 2 years. His examination demonstrates hypophonia, masked facies, decreased blink rate and rigidity. An intermittent right blink rate rigidity. An intermittent right upper extremity resting tremor is noted while he is walking. What is the most likely diagnosis?

December 26, 2020 7:47 am Published by

Parkinson’s disease