neuro cases Flashcards
A 25-year-old female presents to her primary care physician with recurrent headaches. She describes episodes of severe headache accompanied by visual disturbances, such as flashing lights and zigzag lines, which usually last for about 30 minutes to an hour before the headache starts. The headache itself is unilateral, pulsating, and lasts for several hours to a day. She also experiences neck pain during these episodes. Her mother and sister also have a history of migraine. What is the most likely diagnosis?
Migraine with aura
A 40-year-old male complains of frequent headaches, occurring almost daily. He describes a sensation of a tight band-like pressure around his head, mostly in the frontal and temporal areas. The pain is bilateral and does not worsen with physical activity. He does not experience any visual disturbances or nausea. He reports occasional neck pain as well. The headaches have been ongoing for the past few months. What is the most likely diagnosis?
Tension-type headache
A 35-year-old male presents with severe, unilateral headaches that occur in clusters lasting for several weeks. He describes the pain as excruciating, centered around his eye, and accompanied by tearing of the eye, nasal congestion, and runny nose. The headaches occur multiple times a day, usually waking him up from sleep. He has a family history of similar headaches. What is the most likely diagnosis?
Cluster headache
A 50-year-old female complains of daily headaches that have become more frequent over the past year. She reports using over-the-counter analgesics almost daily to relieve her headaches. The headaches have become more severe and disabling, and she has noticed that the analgesics provide less relief over time. What is the most likely cause of her worsening headaches?
Medication overuse headache
A 30-year-old female presents with a history of episodic migraines that have become more frequent over the past year. She now experiences headaches on more than 15 days per month, with some days having a milder headache while others are more severe. She also reports neck pain during the headaches. She has been taking analgesics regularly for relief. What is the most likely diagnosis?
Chronic migraine
localization
A 55-year-old male presents with weakness and atrophy in his right hand. He also notices difficulty gripping objects and has a weakened grip strength. There are no sensory deficits in the hand. On examination, there is wasting of the thenar eminence and weakness of thumb abduction and opposition. The rest of the hand muscles are unaffected. Which of the following is the most likely localization of the lesion?
A) Isolated muscle disease
B) Neuromuscular junction disease
C) Peripheral nerve disease
D) Radicular (roots) disease
E) AHC disease
Answer: C) Peripheral nerve disease
Explanation: The patient’s presentation with weakness and atrophy in a specific muscle group (thenar eminence) along with no sensory deficits suggests a peripheral nerve lesion, specifically affecting the median nerve. The median nerve innervates the muscles of the thenar eminence and provides sensory innervation to the palmar aspect of the thumb, index, middle, and half of the ring finger. The localization of the lesion is at the level of the peripheral nerve.
A 35-year-old female presents with bilateral weakness in her upper and lower limbs. The weakness is more pronounced in the proximal muscles, and she also complains of muscle bulkiness. There are no sensory deficits, involuntary movements, or incoordination. On examination, there is hypotonia and late hyporeflexia. Which of the following is the most likely cause of her weakness?
A) Isolated muscle disease
B) Neuromuscular junction disease
C) Peripheral nerve disease
D) Radicular (roots) disease
E) AHC disease
Answer: A) Isolated muscle disease
Explanation: The patient’s presentation with bilateral weakness, more pronounced in proximal muscles, along with muscle bulkiness (late atrophy) and absence of sensory deficits, involuntary movements, or incoordination suggests an isolated muscle disease like sarcomas. Isolated muscle diseases usually cause localized symptoms and a surgical mass, which is not a neurological disease. The hypotonia and late hyporeflexia are consistent with muscle pathology.
A 45-year-old male presents with significant fatigability and weakness that worsens as the day progresses. He first notices weakness in his extraocular muscles, resulting in double vision, and later experiences weakness in his limbs. There is no change in muscle tone, no involuntary movements, and no incoordination. On examination, there is hyperreflexia. Which of the following is the most likely diagnosis?
A) Isolated muscle disease
B) Neuromuscular junction disease
C) Peripheral nerve disease
D) Radicular (roots) disease
E) AHC disease
B) Neuromuscular junction disease
Explanation: The patient’s presentation with diurnal variation, initial involvement of the extraocular muscles, followed by skeletal muscle weakness, and hyperreflexia suggests a neuromuscular junction (NMJ) disease. Myasthenia gravis (MG) is a common NMJ disease characterized by fatigability and weakness that worsen with activity and improve with rest. In primary MG, cranial weakness is usually the initial manifestation, while in secondary MG, skeletal muscle weakness may occur earlier. The absence of change in muscle tone, involuntary movements, or incoordination is consistent with NMJ pathology.
A 60-year-old female presents with weakness and atrophy in her right leg. She notices difficulty walking and dragging her foot while walking. There are no sensory deficits in the leg. On examination, there is weakness of ankle dorsiflexion and toe extension, along with a decreased muscle tone. The rest of the leg muscles are unaffected. Which of the following is the most likely localization of the lesion?
A) Isolated muscle disease
B) Neuromuscular junction disease
C) Peripheral nerve disease
D) Radicular (roots) disease
E) AHC disease
D) Radicular (roots) disease
Explanation: The patient’s presentation with weakness and atrophy in a specific muscle group (ankle dorsiflexors and toe extensors) along with no sensory deficits suggests a radicular (roots) disease. The motor nerves that innervate the ankle dorsiflexors and toe extensors arise from the L4-L5 spinal nerve roots. The localization of the lesion is at the level of the nerve roots
A 50-year-old male presents with bilateral weakness, atrophy, and fasciculations in his upper and lower limbs. He also notices tongue fasciculations. There are no sensory deficits, sphincter impairment, or abdominal reflex abnormalities. On examination, there is hyperreflexia. Which of the following is the most likely diagnosis?
A) Isolated muscle disease
B) Neuromuscular junction disease
C) Peripheral nerve disease
D) Radicular (roots) disease
E) AHC
E) AHC (Anterior Horn Cell) disease
Explanation: The patient’s presentation with bilateral weakness, atrophy, and fasciculations in both upper and lower limbs, along with tongue fasciculations, hyperreflexia, and the absence of sensory deficits, sphincter impairment, or abdominal reflex abnormalities suggests an anterior horn cell (AHC) disease. AHC diseases, such as amyotrophic lateral sclerosis (ALS), affect the motor neurons in the anterior horn cells of the spinal cord. These diseases result in muscle weakness, atrophy, and fasciculations due to the degeneration of the motor neurons. The hyperreflexia is a characteristic finding in AHC diseases.
