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A 37 years old woman presents with a 12-year history of episodic headaches. She experiences these 4 times a week, typically beginning at the end of a workday. The pain is generalized and described as similar to wearing a tight band around her head. The headaches are bothersome, but not disabling, and she denies any nausea or vomiting. She is slightly sensitive to noise but has no photophobia. Pain during her attacks typically responds to ibuprofen. Examination reveals tenderness of her scalp and both trapezius muscles. What is the most likely diagnosis?

December 27, 2020 6:39 am Published by

Tension headache

An 18 years old girl presents with several episodes of confusion over the past several months. Typically, she experiences a warning signal, which she describes as a rising sensation within her abdomen that travels upward through her chest. She is usually unaware for a few minutes, but others have told her that she smacks her lips, picks at her clothing, and a headache, and prefers to lie down. She notes that her memory has not been as good as it was in the past, and her school grades have declined. What potential sequelae do you need to be concerned about?

December 27, 2020 6:38 am Published by

Increased likelihood of accidents, status epilepticus and self harm

An 18 years old girl presents with several episodes of confusion over the past several months. Typically, she experiences a warning signal, which she describes as a rising sensation within her abdomen that travels upward through her chest. She is usually unaware for a few minutes, but others have told her that she smacks her lips, picks at her clothing, and a headache, and prefers to lie down. She notes that her memory has not been as good as it was in the past, and her school grades have declined. What are the most important differential diagnoses?

December 27, 2020 6:37 am Published by

Of the relevant differential diagnoses, it is important to rule out brain tumor, movement disorders and substance induced or febrile... View Article

An 18 years old girl presents with several episodes of confusion over the past several months. Typically, she experiences a warning signal, which she describes as a rising sensation within her abdomen that travels upward through her chest. She is usually unaware for a few minutes, but others have told her that she smacks her lips, picks at her clothing, and a headache, and prefers to lie down. She notes that her memory has not been as good as it was in the past, and her school grades have declined. What is the most likely diagnosis?

December 27, 2020 6:37 am Published by

Focal seizures

A 16 years old male presents with a first-time seizure event after attending an all-night party and consuming alcohol. Witnesses described the seizure as beginning abruptly with bilateral limb stiffening, followed by jerking movements in all limbs; the patient has no memory of warning symptoms prior to the seizure. The event seemed to last about 1 minute, and the patient was quite somnolent afterward. Further review of the history reveals that the patient has been experiencing “jerks” in the morning after awakening usually involving the arms and shoulders and occasionally causing him to drop things. These “jerks” do not seem to present a problem during the rest of the day. What potential sequelae do you need to be concerned about?

December 27, 2020 6:36 am Published by

Increased likelihood of accidents, status epilepticus and self harm

A 16 years old male presents with a first-time seizure event after attending an all-night party and consuming alcohol. Witnesses described the seizure as beginning abruptly with bilateral limb stiffening, followed by jerking movements in all limbs; the patient has no memory of warning symptoms prior to the seizure. The event seemed to last about 1 minute, and the patient was quite somnolent afterward. Further review of the history reveals that the patient has been experiencing “jerks” in the morning after awakening usually involving the arms and shoulders and occasionally causing him to drop things. These “jerks” do not seem to present a problem during the rest of the day. What are the most important differential diagnoses?

December 27, 2020 6:35 am Published by

Of the relevant differential diagnoses, it is important to rule out brain tumor,movement disorders and substance induced or febrile seizures.

A 16 years old male presents with a first-time seizure event after attending an all-night party and consuming alcohol. Witnesses described the seizure as beginning abruptly with bilateral limb stiffening, followed by jerking movements in all limbs; the patient has no memory of warning symptoms prior to the seizure. The event seemed to last about 1 minute, and the patient was quite somnolent afterward. Further review of the history reveals that the patient has been experiencing “jerks” in the morning after awakening usually involving the arms and shoulders and occasionally causing him to drop things. These “jerks” do not seem to present a problem during the rest of the day. What is the most likely diagnosis?

December 27, 2020 6:34 am Published by

Grand-mal seizure

A 60 years old man presents with increased incidence of stumbling and loss of balance, which has developed gradually over the last year. The patient reports associated muscle twitching and painful muscle cramps in the legs, and has also noticed he occasionally has difficulty swallowing. The neurologic examination is pertinent for bilateral lower-extremity weakness, more severe on the right, with foot intrinsic muscles, diffuse fasciculations, and hyperreflexia, with deep tendon reflexes being brisker on the right lower extremity, and a positive right Babinski sign. Sensation is preserved throughout. What potential sequelae do you need to be concerned about?

December 26, 2020 8:35 am Published by

Aspiration pneumonitis and death due to respiratory failure

A 60 years old man presents with increased incidence of stumbling and loss of balance, which has developed gradually over the last year. The patient reports associated muscle twitching and painful muscle cramps in the legs, and has also noticed he occasionally has difficulty swallowing. The neurologic examination is pertinent for bilateral lower-extremity weakness, more severe on the right, with foot intrinsic muscles, diffuse fasciculations, and hyperreflexia, with deep tendon reflexes being brisker on the right lower extremity, and a positive right Babinski sign. Sensation is preserved throughout. What are the most important differential diagnoses?

December 26, 2020 8:34 am Published by

Of the relevant differential diagnoses, it is important to consider cervical spondylosis causing myelopathy, myasthenia gravis, primary lateral sclerosis, spinal... View Article

A 60 years old man presents with increased incidence of stumbling and loss of balance, which has developed gradually over the last year. The patient reports associated muscle twitching and painful muscle cramps in the legs, and has also noticed he occasionally has difficulty swallowing. The neurologic examination is pertinent for bilateral lower-extremity weakness, more severe on the right, with foot intrinsic muscles, diffuse fasciculations, and hyperreflexia, with deep tendon reflexes being brisker on the right lower extremity, and a positive right Babinski sign. Sensation is preserved throughout. What is the most likely diagnosis?

December 26, 2020 8:31 am Published by

Amyotrophic lateral sclerosis