Archives

A 63 years old man sustained a cut on his hand while gardening. He presents with signs of generalized muscle stiffness and trismus, and appears to be grimacing. Intermittent tonic contraction of his skeletal muscles causes intensely painful spasms, which last for minutes, during which he retains consciousness. During a generalized spasm the patient arches his back, extends his legs, flexes his arms in abduction, and, and clenches his fists. He also experiences dysphagia and apneic periods. Clinical exam reveals hyperpyrexia, cardiac arrhythmias, and hypotension. What potential sequelae do you need to be concerned about?

December 26, 2020 8:29 am Published by

Rhabdomyolysis leading to acute renal failure and death secondary to paralysis of pharyngeal and respiratory muscles

A 63 years old man sustained a cut on his hand while gardening. He presents with signs of generalized muscle stiffness and trismus, and appears to be grimacing. Intermittent tonic contraction of his skeletal muscles causes intensely painful spasms, which last for minutes, during which he retains consciousness. During a generalized spasm the patient arches his back, extends his legs, flexes his arms in abduction, and, and clenches his fists. He also experiences dysphagia and apneic periods. Clinical exam reveals hyperpyrexia, cardiac arrhythmias, and hypotension. What are the most important differential diagnoses?

December 26, 2020 8:27 am Published by

Of the relevant differential diagnoses, it is important to rule out meningitis and neuroleptic malignant syndrome.

A 63 years old man sustained a cut on his hand while gardening. He presents with signs of generalized muscle stiffness and trismus, and appears to be grimacing. Intermittent tonic contraction of his skeletal muscles causes intensely painful spasms, which last for minutes, during which he retains consciousness. During a generalized spasm the patient arches his back, extends his legs, flexes his arms in abduction, and, and clenches his fists. He also experiences dysphagia and apneic periods. Clinical exam reveals hyperpyrexia, cardiac arrhythmias, and hypotension. What is the most likely diagnosis?

December 26, 2020 8:26 am Published by

Tetanus

A 75 years old man with an unremarkable past medical history presents with a complaint of new headache for the past 2 weeks. He notes that the headache is localized over the left temple and he has noticed associate jaw pain and chewing discomfort. His medical history is unremarkable with the exception of occasional complaints of pain and stiffness in the shoulders and hips, which are worse in the morning but progressively improved throughout the day. Laboratory evaluation demonstrates evidence of inflammation, including an elevated ESR, C-reactive protein, and platelets. What potential sequelae do you need to be concerned about?

December 26, 2020 8:25 am Published by

Blindness, large vessels stenosis and aortic aneurysm

A 75 years old man with an unremarkable past medical history presents with a complaint of new headache for the past 2 weeks. He notes that the headache is localized over the left temple and he has noticed associate jaw pain and chewing discomfort. His medical history is unremarkable with the exception of occasional complaints of pain and stiffness in the shoulders and hips, which are worse in the morning but progressively improved throughout the day. Laboratory evaluation demonstrates evidence of inflammation, including an elevated ESR, C-reactive protein, and platelets. What are the most important differential diagnoses?

December 26, 2020 8:24 am Published by

Of the relevant differential diagnoses, it is important to rule out subarachnoid hemorrhage, intracranial aneurysms, Takayasu arteritis and chronic infection.

A 75 years old man with an unremarkable past medical history presents with a complaint of new headache for the past 2 weeks. He notes that the headache is localized over the left temple and he has noticed associate jaw pain and chewing discomfort. His medical history is unremarkable with the exception of occasional complaints of pain and stiffness in the shoulders and hips, which are worse in the morning but progressively improved throughout the day. Laboratory evaluation demonstrates evidence of inflammation, including an elevated ESR, C-reactive protein, and platelets. What is the most likely diagnosis?

December 26, 2020 8:23 am Published by

Temporal (Giant cell) arteritis

A 32 years old woman presents with a 13-year history of disabling, pounding pain over one temple that occurs a few times per month. She reports that the headaches come on gradually with nausea and sensitivity to light, and, when particularly severe, distort the vision in the ipsilateral eye. She says that her headaches can be triggered by lack of sleep, are worse with physical exertion, and are more common during menses. On a few occasions, headaches were preceded by the gradual appearance of a shimmering, zigzag line that enlarged, moved to the peripheral visual field and then faded away over 45 minutes. Untreated, they last for 2 days. Physical examinations are unremarkable. What potential sequelae do you need to be concerned about?

December 26, 2020 8:22 am Published by

Impaired social and occupational functioning and depression

A 32 years old woman presents with a 13-year history of disabling, pounding pain over one temple that occurs a few times per month. She reports that the headaches come on gradually with nausea and sensitivity to light, and, when particularly severe, distort the vision in the ipsilateral eye. She says that her headaches can be triggered by lack of sleep, are worse with physical exertion, and are more common during menses. On a few occasions, headaches were preceded by the gradual appearance of a shimmering, zigzag line that enlarged, moved to the peripheral visual field and then faded away over 45 minutes. Untreated, they last for 2 days. Physical examinations are unremarkable. What are the most important differential diagnoses?

December 26, 2020 8:22 am Published by

Of the relevant differential diagnoses, it is important to rule out pituitary or brain tumor, increased intracranial pressure, meningeal irritation,... View Article

A 32 years old woman presents with a 13-year history of disabling, pounding pain over one temple that occurs a few times per month. She reports that the headaches come on gradually with nausea and sensitivity to light, and, when particularly severe, distort the vision in the ipsilateral eye. She says that her headaches can be triggered by lack of sleep, are worse with physical exertion, and are more common during menses. On a few occasions, headaches were preceded by the gradual appearance of a shimmering, zigzag line that enlarged, moved to the peripheral visual field and then faded away over 45 minutes. Untreated, they last for 2 days. Physical examinations are unremarkable. What is the most likely diagnosis?

December 26, 2020 8:21 am Published by

Migraine

A 67 years old man presents with rapid onset of right-sided weakness and a subjective feeling of decreased sensation on his right side. His family reported that he seemed to have difficulty forming sentences. Symptoms were maximal within a minute and began to spontaneously abate 5 minutes later. On arrival, 30 minutes after onset, his clinical deficits had largely resolved with the exception of a subtle weakness of his right hand. His history is significant for hypertension, diabetes, hyperlipidemia, and a 50 pack-year smoking habit. What potential sequelae do you need to be concerned about?

December 26, 2020 8:20 am Published by

Stroke, myocardial infarction, and seizure