Clinical Cases

Question 1

30 y/o male presents with stab wound in back. Patient displays right-sided weakness starting at T5 and left-sided loss of pinprick sensation and temperature starting at T7.

Answer 1

Brown-sequard syndrome.

Weakness/ paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianaesthesia) on the opposite side = Brown Sequard Syndrome.

Question 2

39 y/o female presents with severe headaches on sneezing.
Examination finds decreased sensation to pinprick over upper back, shoulder and upper arms.
- Power in arms is 2/5.
- Power in lower body is 5/5.

Answer 2

Syringomyelia.

cyst forms in spinal cord, expands and compresses spinal cord - causes loss of feeling, paralysis, weakness and stiffness in the back/shoulders/extremities.

Question 3

What investigation would provide a definitive diagnosis?
70 y/o with progressive headaches and nausea, with gradual loss of sensation in her right arm.
Imaging reveals a mass in the temporal lobe.

Answer 3

Biopsy.

Question 4

What investigation would provide a definitive diagnosis?
25 y/o boxer lost consciousness in final fight due to a punch to the head but was fine straight after. However, 4 hours later his GCS is 6/15.

Answer 4

CT scan.

Question 5

What investigation would provide a definitive diagnosis?

25 y/o male developed sudden onset “worst ever” headache and collapsed.

Answer 5

CT angiography.

(Subarachnoid haemorrhage).