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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 is the most likely diagnosis?

December 27, 2020 7:07 am Published by

Intracranial hypertension

A 25 years old woman presents with recurrent slurring of speech that worsens when she continues to talk. She has trouble swallowing, which deteriorates when she continues to eat, and has double vision that gets worse when sewing, reading, or watching TV. She reports that her head is heavy and hard to hold up. Her symptoms have progressively deteriorated over the past 6 months. She has intermittent weakness in her legs and arms, and is fearful of falling due to her legs giving out. She reports a feeling of generalized fatigue and is occasionally short of breath. What potential sequelae do you need to be concerned about?

December 27, 2020 7:05 am Published by

Respiratory failure and aspiration pneumonitis

A 25 years old woman presents with recurrent slurring of speech that worsens when she continues to talk. She has trouble swallowing, which deteriorates when she continues to eat, and has double vision that gets worse when sewing, reading, or watching TV. She reports that her head is heavy and hard to hold up. Her symptoms have progressively deteriorated over the past 6 months. She has intermittent weakness in her legs and arms, and is fearful of falling due to her legs giving out. She reports a feeling of generalized fatigue and is occasionally short of breath. What are the most important differential diagnoses?

December 27, 2020 7:05 am Published by

Of the relevant differential diagnoses, it is important to rule out Lambert-Eaton syndrome poliomyelitis, multiple sclerosis and botulism.

A 25 years old woman presents with recurrent slurring of speech that worsens when she continues to talk. She has trouble swallowing, which deteriorates when she continues to eat, and has double vision that gets worse when sewing, reading, or watching TV. She reports that her head is heavy and hard to hold up. Her symptoms have progressively deteriorated over the past 6 months. She has intermittent weakness in her legs and arms, and is fearful of falling due to her legs giving out. She reports a feeling of generalized fatigue and is occasionally short of breath. What is the most likely diagnosis?

December 27, 2020 7:03 am Published by

Myasthenia gravis

A 62 years old man presents with a 6-month history of generalized fatigue and weakness. He initially noted difficulty ascending stairs and walking prolonged distances. Over the past several months, he has also developed intermittent dysarthria, difficulty raising his arms above his head, and impotence. On examination, prominent weakness in the pelvic and shoulder girdles with mild distal leg weakness is noted. Reflexes are initially absent, although they are obtainable after a brief period of exercise. Sensation and coordination are normal. What potential sequelae do you need to be concerned about?

December 27, 2020 7:02 am Published by

Aspiration pneumonitis and respiratory failure

A 62 years old man presents with a 6-month history of generalized fatigue and weakness. He initially noted difficulty ascending stairs and walking prolonged distances. Over the past several months, he has also developed intermittent dysarthria, difficulty raising his arms above his head, and impotence. On examination, prominent weakness in the pelvic and shoulder girdles with mild distal leg weakness is noted. Reflexes are initially absent, although they are obtainable after a brief period of exercise. Sensation and coordination are normal. What are the most important differential diagnoses?

December 27, 2020 7:02 am Published by

Of the relevant differential diagnoses, it is important to rule out myasthenia gravis, Guillain-Barre syndrome and botulism.

A 62 years old man presents with a 6-month history of generalized fatigue and weakness. He initially noted difficulty ascending stairs and walking prolonged distances. Over the past several months, he has also developed intermittent dysarthria, difficulty raising his arms above his head, and impotence. On examination, prominent weakness in the pelvic and shoulder girdles with mild distal leg weakness is noted. Reflexes are initially absent, although they are obtainable after a brief period of exercise. Sensation and coordination are normal. What is the most likely diagnosis?

December 27, 2020 7:01 am Published by

Lambert-Eaton myasthenic syndrome

A 55 years old man who worked as a technician developed difficulty findings words 2 years earlier, which has evolved into dysfluency, frequent repetition of remarks and questions, stereotypies (purposeless behaviors or fragments of speech frequently repeated, without regard to context), and echolalia. In the past year, he has also become forgetful and restless, and has developed rigid routines. His work efficiency deteriorated due to his poor comprehension, reasoning, planning, and completion, resulting in disability leave. His wife reports he has became unfeeling, intrusive (indiscriminately approaching strangers), childlike, and impulsive. On the exam, he is pleasant and cooperative. Depression is not evident, and he does not have euphoria, psychosis, or paranoia. Speech is mildly nonfluent and verbal fluency is impaired. Mini-mental state exam score is 29. What potential sequelae do you need to be concerned about?

December 27, 2020 7:00 am Published by

Depression and suicide

A 55 years old man who worked as a technician developed difficulty findings words 2 years earlier, which has evolved into dysfluency, frequent repetition of remarks and questions, stereotypies (purposeless behaviors or fragments of speech frequently repeated, without regard to context), and echolalia. In the past year, he has also become forgetful and restless, and has developed rigid routines. His work efficiency deteriorated due to his poor comprehension, reasoning, planning, and completion, resulting in disability leave. His wife reports he has became unfeeling, intrusive (indiscriminately approaching strangers), childlike, and impulsive. On the exam, he is pleasant and cooperative. Depression is not evident, and he does not have euphoria, psychosis, or paranoia. Speech is mildly nonfluent and verbal fluency is impaired. Mini-mental state exam score is 29. What are the most important differential diagnoses?

December 27, 2020 6:59 am Published by

Of the relevant differential diagnoses, it is important to rule out brain tumor, cerebrovascular insufficiency, and substance abuse (intoxication or... View Article

A 55 years old man who worked as a technician developed difficulty findings words 2 years earlier, which has evolved into dysfluency, frequent repetition of remarks and questions, stereotypies (purposeless behaviors or fragments of speech frequently repeated, without regard to context), and echolalia. In the past year, he has also become forgetful and restless, and has developed rigid routines. His work efficiency deteriorated due to his poor comprehension, reasoning, planning, and completion, resulting in disability leave. His wife reports he has became unfeeling, intrusive (indiscriminately approaching strangers), childlike, and impulsive. On the exam, he is pleasant and cooperative. Depression is not evident, and he does not have euphoria, psychosis, or paranoia. Speech is mildly nonfluent and verbal fluency is impaired. Mini-mental state exam score is 29. What is the most likely diagnosis?

December 27, 2020 6:59 am Published by

Fronto-temporal dementia