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A 68-year-old woman with a history of diabetes and hypertension presented urgently to the ED with a 2-day history of headaches and confusion. Before any imaging was able to be completed in the emergency room, the patient had a cardiac arrest and died. An autopsy was requested by the family. A gross pathologic image of the patient’s brain is shown below. What is the most likely etiology of the findings seen in this image?
A study published in 1992 indiscriminately assigned 457 patients with optic neuritis to receive either 14 days of oral prednisone, 3 days of intravenous methylprednisolone followed by 11 days of prednisone, or an oral placebo for 14 days as an acute therapy. Visual function testing was performed intermittently over a six-month follow-up period. The results showed that patients who received methylprednisolone followed by oral prednisone had a faster rate of visual recovery. What type of study design was this?
A 42-week gestational age female was born vaginally to a mother with a history of type 2 diabetes. Delivery was complicated by shoulder dystocia and required assistance with forceps. Apgar scores at 1 and 5 minutes were seven and nine, respectively. Her birth weight was 9 pounds and 6 ounces. Examination after birth showed there was no appreciable left arm bicep or deltoid function. What is the most likely etiology for this finding?
A 32-year-old man with a 4-week history of painful swelling on his right forehead presents to the emergency room. A CT scan of the head was performed and is shown below. What is the most likely diagnosis?
A patient with a history of low back pain had an MRI of their lumbar spine completed as part of their workup. The T2 FLAIR image of the lumbar spine MRI is shown below. What is the most likely diagnosis?
A patient with relapsing-remitting multiple sclerosis presents to the emergency department with a new headache, confusion, and vision loss. A T2 sequence from their MRI is shown below. Lumbar puncture is positive for JCV in the CSF. What is the mechanism of action of the disease-modifying therapy most likely to be attributed to this clinical scenario?
A patient with a history of a right shoulder anterior dislocation comes to the clinic with the chief complaint of right arm numbness. On examination, there is a loss of sensation to light touch on the lateral portion of the upper arm. Based on the sensory disturbance, which of the following nerves is most likely injured?
An 8-year-old girl is brought to the clinic by her mother for complaints of progressive insomnia, difficulty walking, and worsening vision. On exam, the patient is found to be unable to look upwards and her pupils accommodate but fail to react to light. On further questioning, it is found that menarche occurred at 7 years of age. MRI is most likely to demonstrate a tumor of which brain structure?
A 41-year-old female smoker with HTN is admitted to the Neuro ICU after having acute onset worst headache of life, found to have hyperdensity tracking sulcal lines on CTH. Her physical exam is otherwise normal on admission. On the fourth day of admission, she develops acute onset right arm and leg weakness and aphasia. She was last seen well 30 minutes prior. Which of the following is true?
Which of the following EEG artifacts is prominently seen on this EEG?
An 80-year-old female presents with abnormal eye movements and cognition. She has also been experiencing problems with gait and memory. An MRI of the brain revealed midbrain atrophy, with relative sparing of the other brainstem structures. Which of the following is the most likely diagnosis?
An 18-year-old male presents to the ED after having his first generalized tonic-clonic seizure. MRI was unremarkable but a routine EEG showed 4-6 Hz polyspike and wave discharges in sleep. Which of the following antiepileptic drugs are most appropriate to start based on the available information?
The abnormalities appreciated on the MRI below are due to a defect in which of the following processes?
A 40-year-old woman is hospitalized at an inpatient psychiatric facility for new behavioral disturbances and a suicide attempt. She has also begun to develop unusual movements of her bilateral upper extremities. The movements are non-rhythmic, high-amplitude, low-frequency, and involve the entire extremity. Her brain MRI is shown below. Which of the following may help to treat her movements?
A patient with a history of focal to bilateral tonic-clonic seizures has an EEG performed to see if they have responded to levetiracetam. Based on the EEG below, from which region of the brain does epileptiform activity arise?
A 33-year-old patient presents in the clinic for evaluation of bilateral leg weakness, and urinary incontinence. He first started noticing right leg weakness about 2 years ago and then a few months later felt similar symptoms developing in his left foot. These symptoms gradually worsened over time to the point that he had to start using a cane because of frequent falls. Imaging of the whole neuroaxis was performed. MRI of the brain showed several periventricular and juxtacortical T2 hyperintensities with no enhancement. A lumbar puncture was performed and it had unique CSF oligoclonal bands. What is the most likely diagnosis?
An EMG/NCS is performed for the evaluation of subacute left upper extremity weakness in an adult female. There are fibrillation potentials in the deltoid and biceps on EMG and decreased median and radial sensory amplitudes on NCS. Which portion of the brachial plexus was injured?
What is the benefit of using glucocorticoids in the treatment of bacterial meningitis?
A 3-day-old male infant is evaluated in the NICU for fever and focal seizures. He was born at 39 weeks gestation via uncomplicated vaginal delivery and had good APGAR scores. Brain imaging shows periventricular calcifications and severe ventriculomegaly. Auditory testing also demonstrates bilateral hearing impairment. What is the most likely cause of the patient’s symptoms?
A 30-year-old female presents to the ER with a three-day history of progressive weakness, double vision, and slurred speech. The first symptoms appreciated were double vision and slurred speech, followed by weakness in the upper extremities. Symptoms then descended to involve the lower extremities. On examination, the patient had decreased tone, areflexia, mydriasis, and restricted extraocular movements bilaterally. A neuromuscular junction disorder is suspected. Based on the most likely diagnosis, which of the following would be seen in this patient’s neurodiagnostic testing?
Deep brain stimulation has been FDA approved for the management of medically refractory epilepsy when it targets which of the following structures?
A newborn male is evaluated in the NICU for a lesion on his lower back. He was born to a mother with no prenatal care at 37 weeks gestation. Imaging of his lower back shows the meninges and spinal cord herniated through the defect, covered in a membrane. His condition could have most likely been prevented through prenatal supplemental with what?
A 37-year-old woman treated for herpes simplex virus (HSV) encephalitis two months ago returns to the ER with new personality changes, seizures, and orofacial dyskinesia. What is the most likely diagnosis?
A 45-year-old male with AIDs presents with headache and fever. His recent CD4 count was 80, and he does not take his HAART therapy or prophylaxis. You perform a brain MRI (shown below) and discover a contrast-enhancing lesion with much vasogenic edema. With concern for cancer, a biopsy is performed. It shows microglial nodules with encysted bradyzoites and tachyzoites. What is the treatment of choice?
A 75-year-old man with a past medical history of hypertension, hyperlipidemia, and diabetes presents with acute onset right arm weakness and speech problems. He can speak fluently and his comprehension is intact. However, he is unable to repeat even simple sentences. Reading and writing are preserved. Which of the following is an accurate description of his speech dysfunction?