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A 53 years old black woman presents with a sudden, excruciating headache that began while sitting at her desk at work. The headache is diffuse, intense, and accompanied by nausea and vomiting. She describes the headache as the worst headache of her life. She is a smoker and her history is significant for hypertension. On examination her level of consciousness appears slightly impaired, with slow reaction time to questions, and she has third cranial nerve palsies. There are no sensory deficits or weaknesses. Fundoscopic exam reveals bilateral retinal hemorrhages. What is the most likely diagnosis?

December 26, 2020 8:07 am Published by

Subarachnoid hemorrhage

A 20 year-old woman with no significant past medical history presents with lower back pain, and bilateral foot and hand tingling. Her symptoms rapidly progress over 4 days to include lower extremity weakness to the point that she is unable to mobilize her lower extremities. She reports coryzal symptoms 2 weeks ago. On examination, she has 0/5 power in her lower extremity with areflexia, but despite the paresthesias, she does not have sensory deficits. Laboratory analysis indicates elevated aminotransferases and mildly elevated protein in the CSF, with no cells and normal glucose. What potential sequelae do you need to be concerned about?

December 26, 2020 8:04 am Published by

Respiratory failure, permanent neurological deficits and paralysis

A 20 year-old woman with no significant past medical history presents with lower back pain, and bilateral foot and hand tingling. Her symptoms rapidly progress over 4 days to include lower extremity weakness to the point that she is unable to mobilize her lower extremities. She reports coryzal symptoms 2 weeks ago. On examination, she has 0/5 power in her lower extremity with areflexia, but despite the paresthesias, she does not have sensory deficits. Laboratory analysis indicates elevated aminotransferases and mildly elevated protein in the CSF, with no cells and normal glucose. What are the most important differential diagnoses?

December 26, 2020 8:04 am Published by

Of the relevant differential diagnoses, it is important to rule out transverse myelitis, myasthenia gravis, Lambert-Eaton syndrome, polymyositis and post-polio... View Article

A 20 year-old woman with no significant past medical history presents with lower back pain, and bilateral foot and hand tingling. Her symptoms rapidly progress over 4 days to include lower extremity weakness to the point that she is unable to mobilize her lower extremities. She reports coryzal symptoms 2 weeks ago. On examination, she has 0/5 power in her lower extremity with areflexia, but despite the paresthesias, she does not have sensory deficits. Laboratory analysis indicates elevated aminotransferases and mildly elevated protein in the CSF, with no cells and normal glucose. What is the most likely diagnosis?

December 26, 2020 8:03 am Published by

Guillain-Barre syndrome

A middle-aged woman presents with difficulty falling asleep and increasing day-time fatigue. She reports taking over an hour to fall asleep, and frequent waking throughout the night. She is perimenopausal and her history is significant for anxiety. Her physical exam and laboratory tests are normal. What are the most important differential diagnoses?

December 26, 2020 8:01 am Published by

Of the relevant differential diagnoses, it is important to rule out sleep apnea, psychiatric disorders and neurological disorders (dementia, Parkinson’s... View Article

A 27 years old woman presents with amenorrhea. She had been taking the combined oral contraceptive pill for the last 9 years, stopping this 11 months ago. She is otherwise healthy, but on physical exam she has bilateral galactorrhea. Laboratory work-up reveals an elevated prolactin level and low-normal gonadotropin (LH, FSH) levels. What potential sequelae do you need to be concerned about?

December 26, 2020 7:59 am Published by

Visual impairments, hypopituitarism, pituitary apoplexy and osteoporosis

A 27 years old woman presents with amenorrhea. She had been taking the combined oral contraceptive pill for the last 9 years, stopping this 11 months ago. She is otherwise healthy, but on physical exam she has bilateral galactorrhea. Laboratory work-up reveals an elevated prolactin level and low-normal gonadotropin (LH, FSH) levels. What are the most important differential diagnoses?

December 26, 2020 7:59 am Published by

Of the relevant differential diagnoses, it is important to consider hypothyroidism, pituitary adenomas and polycystic ovarian disease.