Cases Flashcards
18/yo male student presents with severe headache and fever that he has had for 3 days. Examination revels photophobia and neck stiffness.
Meningitis
56y/o man presents to A&E with headache, fever, blurred vision and somnolence followed shortly by unresponsiveness to verbal commands. For the last 2wks he had been feeling ill and had decreases appetite and myalgia. 3 days prior to presentation he experienced intermittent confusion, severe headache and fever. Examination was limited by a tonic-clonic seizure.
Encephalitis
76y/o woman is brought to her GP by her daughter as she is becoming more forgetful. She used to pay her bills independently and enjoyed cooking but has recently received overdue notices from utility companies and found it difficult to prepare a balanced meal. When her children express their concerns, she becomes irritable and resists their help. No significant PMHx. MMSE score is 20/30.
Alzheimer’s disease
65y/o man presents with difficulty in decision-making and planning, which is of abrupt onset and occurs 3mths after a stoke. PMHx includes hypertension and angina. Over time there has been a fluctuating stepwise reduction in cognitive function.
Vascular dementia
78y/o woman presents with confusion, agitation and visual hallucinations. She has become progressively confused over the past 2 years and has had trouble managing her affairs, such as shopping and paying bills. Initially she struggled to follow a conversation and found herself getting lost on several occasions. She started to shuffle about 6mths ago and had difficulty getting out of chairs, and getting dressed to go out seemed to take hours.
Lewy-body dementia
58y/o male teacher developed dystopia, spelling errors, impaired comprehension of reading and conversation. He also has impaired attention, planning and organisation, along with declining self-care, child-like behaviour and altered social habits (e.g. eating meals with his fingers).
Frontal-Temporal dementia
16y/o boy presents to A&E with a 1st-time seizure 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 the event but recalls a strange smell prior to the episode.
Epilepsy
44y/o male smoker presents with a 9-month history of severe headaches. These occur around his left eye and do not spread to anywhere else. He tells you he suffers around 4 or 5 a day for a week, followed by a month without any headaches before they start up again in a similar fashion.
Cluster headache
32y/o woman presents with a 13yr history of 1-3 attacks per month of a disabling pain over her right temple. She feels nauseous during these attacks and finds she has to stop what she’s doing and lie in a darkened room. She notices “funny lines” appearing prior to each attack.
Migraine with aura
Middle aged woman presents with a complaint of frequent (once or twice daily for 3wks), brief (lasting several seconds) episodes of intense, sharp left-sided jaw pain. She has experienced these attacks for several years, but they had previously been relatively rare. She says that episodes are sometimes brought on by eating but can occur without an apparent stimulus.
Trigeminal neuralgia
75 y/o man presents with problems walking that have developed over the previous 2yrs, consisting of slow gait, imbalance (especially on turning), short stride length and gait initiation failure. He reports urinary frequency, occasional urge incontinence and some memory loss. On examination, his symptoms are symmetrical and much more prominent in the lower half of the body, with relative sparing of hand function and normal facial expressiveness.
Hydrocephalus
60y/o man presents with progressive headache and cognitive decline. A MRI of the brain without gadolinium enhancement demonstrates a large extra-axial lesion that is similar intensity to brain on T1 images.
Meningioma
35y/o right-handed man presents with a partial seizure involving jerky movements of his right arm and the right side of his face. He also reports left-sided headaches for a few months and clumsiness of his right hand. On examination he has a subtle facial droop and pronator drift on the right side.
Astrocytoma
53y/o black woman complains of a sudden, excruciating headache while sitting at work. The headache is diffuse, intense and accompanied by N&V. She describes it as the worst headache of her life, before losing consciousness.
Subarachnoid haemorrhage
Young man is brought to A&E after being involved in a high-speed motor vehicle accident. He was an unrestrained driver, and no airbags were deployed. He has multiple areas of abrasion, lacerations and ecchymosis about his scalp and face. On neurological examination, he does not open his eyes to painful stimuli; he is intubated and he withdraws his left side to pain. q
Subdural haemorrhage