#neurology
#stroke
ID: 72-year-old woman
Chief Complaint:
Left-sided weakness for 1 hour
History of Present Illness (HPI):
Patient was brought to the ED by her daughter due to sudden onset left-sided weakness that began 1 hour prior to arrival. No associated headache, visual changes, or sensory loss reported.
Past Medical History (PMH):
Hypertension
Hypercholesterolemia
Type 2 diabetes mellitus
Coronary artery disease
Medications:
Atorvastatin
Amlodipine
Metformin
Aspirin
Social History:
Smokes ~½ pack/day for 45 years (~22.5 pack-years)
No alcohol or illicit drug history mentioned
Review of Systems (ROS):
Negative for headache
Negative for blurred vision
No sensory complaints
Physical Examination
Vital Signs:
T: 37°C (98.6°F)
HR: 92/min, regular
BP: 168/90 mmHg
RR: not provided
SpO₂: not provided
General:
Alert, cooperative
Neurological:
Cranial Nerves: Left facial droop
Motor: Decreased strength in left upper and lower extremities
Reflexes: DTRs 3+ on the left
Sensory: Normal to pinprick, light touch, vibration, and two-point discrimination
Coordination: Not mentioned
Gait: Not assessed
Which of the following is the most likely cause of these findings?
A) Atherosclerosis of the internal carotid artery
B) Rupture of an intracranial aneurysm
C)Lipohyalinosis of lenticulostriate arteries
D) Dissection of the vertebral artery
E)Embolism from the left atrium
#stroke
ID: 72-year-old woman
Chief Complaint:
Left-sided weakness for 1 hour
History of Present Illness (HPI):
Patient was brought to the ED by her daughter due to sudden onset left-sided weakness that began 1 hour prior to arrival. No associated headache, visual changes, or sensory loss reported.
Past Medical History (PMH):
Hypertension
Hypercholesterolemia
Type 2 diabetes mellitus
Coronary artery disease
Medications:
Atorvastatin
Amlodipine
Metformin
Aspirin
Social History:
Smokes ~½ pack/day for 45 years (~22.5 pack-years)
No alcohol or illicit drug history mentioned
Review of Systems (ROS):
Negative for headache
Negative for blurred vision
No sensory complaints
Physical Examination
Vital Signs:
T: 37°C (98.6°F)
HR: 92/min, regular
BP: 168/90 mmHg
RR: not provided
SpO₂: not provided
General:
Alert, cooperative
Neurological:
Cranial Nerves: Left facial droop
Motor: Decreased strength in left upper and lower extremities
Reflexes: DTRs 3+ on the left
Sensory: Normal to pinprick, light touch, vibration, and two-point discrimination
Coordination: Not mentioned
Gait: Not assessed
Which of the following is the most likely cause of these findings?
A) Atherosclerosis of the internal carotid artery
B) Rupture of an intracranial aneurysm
C)Lipohyalinosis of lenticulostriate arteries
D) Dissection of the vertebral artery
E)Embolism from the left atrium
❤2
❤2
#neurology
A 54-year-old woman comes to the physician because of paresthesias and weakness in her left leg for one year. Her symptoms have become progressively worse during this period and have led to some difficulty walking for the past month. She has had frequent headaches for the past 4 months. She has a history of hypertension and hypothyroidism. Current medications include amlodipine and levothyroxine. Her temperature is 37.3°C (99.1°F), pulse is 97/min, and blood pressure is 110/80 mm Hg. Neurological examination shows decreased muscle strength in the left lower extremity. Deep tendon reflexes of the lower extremity are 4+ on the left and 2+ on the right side. The remainder of the examination shows no abnormalities. A complete blood count and serum concentrations of electrolytes, glucose, creatinine, and calcium are within the reference ranges. An MRI of the brain is shown. Which of the following is the most appropriate next step in management?
A)Surgical resection
B)Whole brain radiotherapy
C)Stereotactic brain biopsy
D)Stereotactic radiosurgery
E)Active surveillance
F)Intrathecal methotrexate therapy
G)Oral temozolomide
A 54-year-old woman comes to the physician because of paresthesias and weakness in her left leg for one year. Her symptoms have become progressively worse during this period and have led to some difficulty walking for the past month. She has had frequent headaches for the past 4 months. She has a history of hypertension and hypothyroidism. Current medications include amlodipine and levothyroxine. Her temperature is 37.3°C (99.1°F), pulse is 97/min, and blood pressure is 110/80 mm Hg. Neurological examination shows decreased muscle strength in the left lower extremity. Deep tendon reflexes of the lower extremity are 4+ on the left and 2+ on the right side. The remainder of the examination shows no abnormalities. A complete blood count and serum concentrations of electrolytes, glucose, creatinine, and calcium are within the reference ranges. An MRI of the brain is shown. Which of the following is the most appropriate next step in management?
A)Surgical resection
B)Whole brain radiotherapy
C)Stereotactic brain biopsy
D)Stereotactic radiosurgery
E)Active surveillance
F)Intrathecal methotrexate therapy
G)Oral temozolomide
❤1
❤1
#ophthalmology_neurology
A 67-year-old woman comes to the emergency department due to an episode of vision loss in the right eye. The patient was at a movie theater when her right eye vision suddenly became "dim" for approximately 10 minutes. Her vision has now recovered but she remains very concerned about the episode. The patient has never had similar symptoms in the past but does report occasional headaches. She has had no focal weakness or numbness. Her medical history is significant for coronary artery disease, hypertension, and type 2 diabetes mellitus. Blood pressure is 130/85 mm Hg and pulse is 65/min and regular. There is a right-sided carotid bruit. Neurologic and funduscopic examinations are unremarkable.
Which of the following is the most likely cause of this patient's symptoms?
A.Choroidal inflammation
B.Demyelinating disorder
C.Elevated intracranial pressure
D.Increased intraocular pressure
E.Large vessel vasculitis
F.Postictal cortical inhibition
G.Retinal embolism
H.Retinal hemorrhage
I.Vascular spasm
A 67-year-old woman comes to the emergency department due to an episode of vision loss in the right eye. The patient was at a movie theater when her right eye vision suddenly became "dim" for approximately 10 minutes. Her vision has now recovered but she remains very concerned about the episode. The patient has never had similar symptoms in the past but does report occasional headaches. She has had no focal weakness or numbness. Her medical history is significant for coronary artery disease, hypertension, and type 2 diabetes mellitus. Blood pressure is 130/85 mm Hg and pulse is 65/min and regular. There is a right-sided carotid bruit. Neurologic and funduscopic examinations are unremarkable.
Which of the following is the most likely cause of this patient's symptoms?
A.Choroidal inflammation
B.Demyelinating disorder
C.Elevated intracranial pressure
D.Increased intraocular pressure
E.Large vessel vasculitis
F.Postictal cortical inhibition
G.Retinal embolism
H.Retinal hemorrhage
I.Vascular spasm
❤1
❤2