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A 25 years old woman presents with increasing headache for 3 to 4 weeks together with confusion, nausea and vomiting, and diplopia for 1 week. On examination she is drowsy, but is able to cooperate with the medical examination. On neurologic examination she has a left 6th cranial nerve palsy, and range of motion in her neck is decreased due to pain and stiffness. The only other pertinent findings are reduced visual acuity and slight photophobia. What are the most important differential diagnoses?

December 27, 2020 7:16 am Published by

Of the relevant differential diagnoses, it is important to rule out brain tumor, prolactinoma and encephalitis.

A 25 years old woman presents with increasing headache for 3 to 4 weeks together with confusion, nausea and vomiting, and diplopia for 1 week. On examination she is drowsy, but is able to cooperate with the medical examination. On neurologic examination she has a left 6th cranial nerve palsy, and range of motion in her neck is decreased due to pain and stiffness. The only other pertinent findings are reduced visual acuity and slight photophobia. What is the most likely diagnosis?

December 27, 2020 7:15 am Published by

Fungal meningitis

A 70 years old man presents with difficulty speaking and comprehending spoken language, and an inability to raise his right arm. His wife reports he was speaking with no noticeable deficits the previous hour. On exam, there are visual field deficits in his left eye and he struggles to answer questions. There is a history of treated HTN and diabetes. What potential sequelae do you need to be concerned about?

December 27, 2020 7:14 am Published by

Permanent neurological deficits, deep vein thrombosis, seizure and death

A 70 years old man presents with difficulty speaking and comprehending spoken language, and an inability to raise his right arm. His wife reports he was speaking with no noticeable deficits the previous hour. On exam, there are visual field deficits in his left eye and he struggles to answer questions. There is a history of treated HTN and diabetes. What are the most important differential diagnoses?

December 27, 2020 7:12 am Published by

Of the relevant differential diagnoses, it is important to rule out a brain tumor, aneurysm, intracerebral hemorrhage, and hypertensive encephalopathy.

A 35 years old male presents with a partial seizure involving jerky movements of his right side of his face. He reports having had left-sided headaches for a few months and clumsiness of his right hand, and on further questioning, admits others have the past few months. On examination, he is awake and oriented. He has a subtle facial droop and pronator drift on the right side. What potential sequelae do you need to be concerned about?

December 27, 2020 7:10 am Published by

Respiratory failure and death

A 35 years old male presents with a partial seizure involving jerky movements of his right side of his face. He reports having had left-sided headaches for a few months and clumsiness of his right hand, and on further questioning, admits others have the past few months. On examination, he is awake and oriented. He has a subtle facial droop and pronator drift on the right side. What are the most important differential diagnoses?

December 27, 2020 7:09 am Published by

Of the relevant differential diagnoses for sudden onset neurological symptoms, brain tumor is the most serious and therefore the most... View Article

A 29 years old woman presents with a 3-month history of increasing headaches and vision loss, both of which are worse in the morning. She describes occasional episodes of bilateral visual gray outs lasting 20 seconds that may be precipitated by bending forward or standing. Over the last 2 weeks she has often heard a “whooshing” sound, synchronous with her pulse, that is more noticeable when she is about to go to sleep. On examination shows bilateral disk swelling. Her blood pressure is 138/88 mmHg, her heart rate is 12 bpm and her respiratory pattern is abnormal. What potential sequelae do you need to be concerned about?

December 27, 2020 7:08 am Published by

Brain damage and permanent neurological deficit

A 29 years old woman presents with a 3-month history of increasing headaches and vision loss, both of which are worse in the morning. She describes occasional episodes of bilateral visual gray outs lasting 20 seconds that may be precipitated by bending forward or standing. Over the last 2 weeks she has often heard a “whooshing” sound, synchronous with her pulse, that is more noticeable when she is about to go to sleep. On examination shows bilateral disk swelling. Her blood pressure is 138/88 mmHg, her heart rate is 12 bpm and her respiratory pattern is abnormal. What are the most important differential diagnoses?

December 27, 2020 7:07 am Published by

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