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A 42 years old female presents with impaired gait and unexpected stumbling. She has become increasingly irritable and is having trouble completing assigned tasks on time at work. Her husband reports that she has become restless, pays less attention to her appearance and social obligations, and at times is anxious and upset. On examination, her speech is somewhat uneven and she is inappropriately flippant. She exhibits random “piano-playing” movements of the digits along with other movements of the limbs, torso, and face, and tandem walking is impaired. On neurological exam, she is unable to keep her tongue fully protruded for 10 seconds and her coordination is impaired. What potential sequelae do you need to be concerned about?

December 26, 2020 7:42 am Published by

Progressive neurological decline, psychological changes and suicide

A 42 years old female presents with impaired gait and unexpected stumbling. She has become increasingly irritable and is having trouble completing assigned tasks on time at work. Her husband reports that she has become restless, pays less attention to her appearance and social obligations, and at times is anxious and upset. On examination, her speech is somewhat uneven and she is inappropriately flippant. She exhibits random “piano-playing” movements of the digits along with other movements of the limbs, torso, and face, and tandem walking is impaired. On neurological exam, she is unable to keep her tongue fully protruded for 10 seconds and her coordination is impaired. What are the most important differential diagnoses?

December 26, 2020 7:42 am Published by

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

A 42 years old female presents with impaired gait and unexpected stumbling. She has become increasingly irritable and is having trouble completing assigned tasks on time at work. Her husband reports that she has become restless, pays less attention to her appearance and social obligations, and at times is anxious and upset. On examination, her speech is somewhat uneven and she is inappropriately flippant. She exhibits random “piano-playing” movements of the digits along with other movements of the limbs, torso, and face, and tandem walking is impaired. On neurological exam, she is unable to keep her tongue fully protruded for 10 seconds and her coordination is impaired. What is the most likely diagnosis?

December 26, 2020 7:41 am Published by

Huntington’s disease

A 56 years old man presents with headache, fever, blurred vision, and somnolence followed shortly by unresponsiveness to verbal commands. For the last 2 weeks he had been feeling ill, and had prior to presentation he experienced intermittent confusion, severe headache, and fever. Examination was limited by a generalized tonic-clonic seizure, for which he received lorazepam. What potential sequelae do you need to be concerned about?

December 26, 2020 7:40 am Published by

Permanent neurological deficits, hypothalamic and autonomic dysfunction, coma and death

A 56 years old man presents with headache, fever, blurred vision, and somnolence followed shortly by unresponsiveness to verbal commands. For the last 2 weeks he had been feeling ill, and had prior to presentation he experienced intermittent confusion, severe headache, and fever. Examination was limited by a generalized tonic-clonic seizure, for which he received lorazepam. What are the most important differential diagnoses?

December 26, 2020 7:39 am Published by

Of the relevant differential diagnoses, it is important to rule out meningitis, toxic or metabolic encephalopathy and malignant hypertension.