New Deck Flashcards
55-y/o male presents with lower extremity weakness and muscle atrophy; physical examination (PE): ⊕ Babinski’s sign, fasciculations, upper extremity hyperreflexia, and spasticity
Amyotrophic lateral sclerosis
65-y/o presents with a gradual decline in memory and inability to complete activities of daily living; head CT: marked enlargement of ventricles and diffuse cortical atrophy
Alzheimer disease
65-y/o female with h/o spinal metastases presents with pain radiating down the back of leg, saddle anesthesia, urinary retention; PE: absent ankle jerk reflexes; lumbar CT: vertebral fracture with large bony fragment in lumbar spinal canal
Cauda equina syndrome
63-y/o male with h/o cartoid atherosclerosis presents with aphasia and right-sided weakness; PE: dense right hemiparesis, ⊕ Babinski’s on right side
Left MCA cerebrovascular accident
20-y/o presents with nausea, vomiting, and headache 2 h after being hit in the temple with a baseball; patient lost consciousness initially but soon recovered; head CT: lens-shaped, right-sided hyperdense mass adjacent to temporal bone
Epidural hematoma
40-y/o with h/o Campylobacter enteritis 1 week ago presents with ascending symmetric muscle weakness; PE: absent reflexes; w/u: CSF shows ↑ protein, normal cellular (albuminocytologic dissociation)
Guillain-Barré syndrome
37-y/o male presents with poor memory, depression, choreiform movements, and hypotonia; FH of a father who died at 45 after worsening tremors and dementia; brain MRI: marked atrophy of the caudate nucleus
Huntington disease
25-y/o with h/o bilateral temporal lobe contusions 1 week ago presents with a sudden increase in appetite, sexual desire, and hyperorality.
Klüver-Bucy syndrome
30-y/o female with insidious onset of diplopia, scanning speech, paresthesias, numbness of right upper extremity, and urinary incontinence; w/u: CSF analysis is ⊕ for oligoclonal bands; MRI shows discrete areas of periventricular demyelination.
MS
65-y/o female with h/o neurofibromatosis type 2 presents with headache, right-sided leg jerking, and worsening mental status; PE: papilledema and right-sided pronator drift; head CT: dural-based, enhancing left-sided baseball-sized tumor
Meningioma
50-y/o with a h/o squamous cell carcinoma of the lung presents with N/V, headache, and diplopia; PE: papilledema, left oculomotor palsy, right pronator drift; brain MRI: multiple round, ring-enhancing, hyperintense cortical, and cerebellar lesions
Metastases to brain
30-y/o female presents with unilateral throbbing headache, nausea, photophobia, and scotoma. Similar symptoms occur monthly at the same time of her menstrual cycle.
Migraine headache
62-y/o with urinary incontinence, loss of short-term memory, and dementia; PE: wide-based gate; head CT: massively dilated ventricular system
Normal pressure hydrocephalus
60-y/o presents with gradual onset of pill-rolling tremor; PE: masked facies, stooped posture, shuffling gait, cogwheel muscle rigidity
Parkinson disease
31-y/o presents with loss of libido, galactorrhea, and irregular menses; PE: bitemporal hemianopia; w/u: negative β-hCG
Prolactinoma (Prolactin-secreting pituitary adenoma)
45-y/o presents with the gradual onset of sharp pain radiating from his buttocks down his leg that began 2 weeks ago while lifting a heavy box; PE: positive straight leg raise
Sciatica (2° to acute herniation of a lumbar disc)
50-y/o with h/o polycystic kidney disease presents with “worst headache of life,” photophobia, nausea; PE: meningismus, impaired consciousness, right eye deviates down and out; w/u: CSF is xanthochromic.
Subarachnoid hemorrhage (2° to ruptured berry aneurysm of posterior communicating artery)
32-y/o male with h/o Arnold-Chiari malformation presents with bilateral upper extremity muscle weakness; PE: loss of pain and temperature sensation, ↓ DTR in upper extremities, and scoliosis; spine MRI: central cavitation of the thoracic spinal cord
Syringomyelia
75-y/o alcoholic male on warfarin for h/o atrial fibrillation presents with declining mental status, headache, and papilledema; head CT: crescenteric, hypodense 2-cm fluid collection along convexity of skull
Chronic subdural hematoma
30-y/o female with ⊕ FH for renal cell carcinoma presents with gait disturbance and blurred vision; PE: retinal hemangiomas, nystagmus, cerebellar ataxia, and dysdiadokinesia; brain MRI: two cerebellar cystic lesions
von Hippel-Lindau disease
50-y/o with h/o alcoholism presents with psychosis, bilateral CN VI palsy, and ataxia; brain MRI: mamillary body atrophy, periventricular hyperintensity on T2, and diffuse cortical atrophy
Wernicke’s encephalopathy
5-y/o boy born 5 weeks premature by spontaneous vaginal delivery is found to have an IQ of 60. Developmentally, he initially sat at 10 months, said his first word at 18 months and walked at 20 months. On physical examination, he currently walks on his tiptoes with a scissoring gait; his legs are hypertonicbilaterally w/ brisk patellar reflexes and upgoing toes.
Cerebral palsy
50-y/o man w/ history of polycystic kidney disease presents to the ED with a progressively worsening headache, which began acutely while working out at the gym. While in the ED he has had a decrease in level of consciousness.
Subarachnoid hemorrhage (secondary to berry aneurysm)
12-mo/o girl with normal development until about the age of 5 months. Since that age, she has regressed in both coordination and language, as she can no longer walk and is not speaking her first words any longer. Her parents have also noticed that she has developed a peculiar behavior of wringing her hands for long periods of time.
Rett syndrome
55-y/o female presenting with headaches and progressive visual loss. Physical exam reveals optic atrophy in the right eye and papilledema in the left.
Foster-Kennedy syndrome (commonly caused by a frontal meningioma causing elevated intracranial pressure and mass effect on a single optic nerve)
52-y/o man who is 10 days s/p embolization of an anterior communicating aneurysm (following subarachnoid bleed) 10 days ago, now presents to the ED with an acute decline in mental status.
Vasospasm
27-y/o man who is asymptomatic is found to have pigmented hamartomas of the iris and pigmented macules on his torso and upper back. Upon questioning, he mentions that father and brother also have these “dark spots” on their skin.
Neurofibromatosis type I
63-y/o man recently diagnosed with lung cancer presents to the ED with acute onset of seizure activity. His family states that he has been more confused and fatigued lately. Hct is obtained and is normal.
Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)
4-mo/o boy of Ashkenazi descent is brought in to see the pediatrician as his mom is concerned about his development. He no longer lifts his head, is less alert, and startles very easily. Upon physical examination, his doctor notices a bright red macula surrounded by a whitish ring.
Tay-Sachs
2-mo/o boy w/ a 2-day history of fever, nasal discharge, and decreased oral intake. Upon physical examination, he is ill appearing, unresponsive to stimulation, and his anterior fontanelle is open and bulging. Fluid from lumbar puncture reveals increased WBC and protein levels and decreased glucose.
Acute bacterial meningitis (Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae)
65-y/o woman with a 4-month history of progressively worse headache presents for evaluation. A subsequent MRI reveals a mass involving the corpus callosum and both frontal lobes. Biopsy shows a poorly differentiated tumor with pleomorphic cells and nuclear atypia.
Glioblastoma multiforme
61-y/o man presents with a broad-based unsteady gait. He denies vertigo. On physical examination, upper limb coordination is within normal limits, and without tremor. However, he is unable to walk in a straight line, and has nystagmus.
Cerebellar vermis lesion
