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A 62-year-old woman with low back pain presents to the emergency department complaining of 4 weeks of a strange sensation when wiping with toilet paper, as well as urinary and fecal incontinence. On exam, she has 5/5 strength throughout her limbs and normal deep tendon reflexes. What is the location of her lesion?
A 24-year-old college student presents with uncontrolled epilepsy. His seizures consist of an aura of déjà vu followed by oral automatisms and periods of unresponsiveness. The neurological examination is normal. MRI of the brain is performed and shown below. What is the etiology of this patient’s epilepsy?
A 47-year-old woman from the Caribbean presents to the clinic with a seven-year history of progressive difficulty with ambulation. The exam is notable for lower extremity spasticity. An MRI is ordered and shows atrophy of the spinal cord without other changes. The clinical and MRI findings for this patient are most likely secondary to which of the following infections?
Paralysis of the stapedius muscle can occur with ipsilateral damage to which cranial nerve?
A 44-year-old woman who was recently started on a new abortive therapy for her migraines presents with a new type of headache described as more severe and with an extremely rapid onset. CT head imaging revealed no acute findings and lumbar puncture testing was unremarkable. Which of the following is the most likely diagnosis?
A 69-year-old man with HTN, CKD, HLD, tension headaches, and gout presents for 6 months of slowly progressive weakness. He has trouble rising from a chair without assistance and lifting objects above his head. On sensory exam, you note a bilateral symmetric loss of proprioception, vibration, and light touch in the feet and distal lower legs. He brings with him an EMG/NCS report from last week from an outside provider. It shows a length-dependent axonal neuropathy, as well as early recruitment and low amplitude action potentials on EMG of the proximal muscles. Serum CK is obtained and 3200. Which of the following is the most likely cause of his problem?
A 45-year-old man suffered a cardiac arrest after a heroin overdose. He received 30 minutes of CPR with an eventual return of spontaneous circulation. After being cooled per post-arrest protocol the patient was rewarmed. 48 hours after being warmed the patient remained in a persistent comatose state with minimal brainstem reflexes. To evaluate the degree of hypoxic-ischemic injury an EEG was ordered. Which of the following EEG patterns carries the worst prognosis after a hypoxic-ischemic injury?
A 32-year-old man with no significant past medical history presents to the emergency department after experiencing a generalized tonic-clonic seizure. His neurological examination was unremarkable. As part of his work-up, an MRI was obtained (see FLAIR axial image below). What is the most appropriate next step in management?
Which of the following is the thalamic relay center for proprioception of the face?
Which of the following structures is supplied by the recurrent artery of Heubner?
A 22-year-old female with chronic daily headaches and other neurological symptoms has an MRI performed as part of her diagnostic workup. Her cervical MRI imaging is provided below. In addition to her chronic daily headaches, what are the most likely additional neurological symptoms she experiences?
A 3-year-old male with a history of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) was referred to neurology by his PCP for concern of a genetic disorder. On examination, the patient appears to have a long face, large ears, and a prominent jaw. Genetic testing shows that the patient has a pathologic gene mutation with over 200 trinucleotide CGG repeats. Which of the following is a comorbidity appreciated in this patient’s neurologic syndrome?
A 38-year-old man presents with a 1-year history of neck pain and left upper extremity weakness. The symptoms started insidiously, and have slowly worsened over time. A sagittal cervical spine MRI is shown below (Left: T2 without contrast. Right: T1 with contrast). Which of the following is the most likely cause of his symptoms?
A 37-year-old male presents with sudden onset of tachycardia and hypertension, followed shortly by unilateral rhythmic facial and then arm jerking. The autonomic symptoms of tachycardia and hypertension are most likely to reflect the involvement of which region of the brain during a seizure?
A patient with Duchenne muscular dystrophy (DMD) most likely has which of the following findings on electromyography (EMG)?
A 24-year-old healthy male with recent right-sided otitis media complicated by mastoiditis presents to the ER with a first-time seizure. On examination the patient is somnolent and febrile, MRI brain shows a right temporal lobe intraparenchymal mass with a solid rim of contrast enhancement and surrounding vasogenic edema, what is the most likely etiology?
A 24-year-old male presents to the clinic with numbness in the hands and feet. He has been experiencing these symptoms since his late teens, but the numbness has gotten progressively worse. Additionally, he has been stumbling and losing his balance more frequently in the past 18 months, and he received a new pair of glasses because he was having trouble with his vision at night. On physical exam, he has decreased sensation to vibration and pinprick in his bilateral lower extremities and palpable, enlarged nerves. Laboratory studies reveal an elevated level of phytanic acid. What is the most likely diagnosis?
A 50-year-old male farmer presents to the emergency department with diarrhea, steatorrhea, weight loss, abdominal pain, and joint pain in his shoulders and hips. He also displays constant rhythmic eye movements and repetitive facial muscle contractions. Intestinal biopsy reveals macrophage inclusions that positively stain with periodic acid-Schiff. What is the most likely etiology of this patient’s presentation?
You are consulted to the psychiatric hospital to see a 48-year-old female with schizophrenia who has been under psychiatric care for 2 weeks after ingesting hundreds of pennies over a prolonged period. You are asked to address her new complaints of numbness in her feet and trouble walking. On exam, she had a broad-based gait and a positive Romberg. What could explain these findings?
Based on the histopathologic findings shown below, how long ago did this patient experience an ischemic stroke?
Per the American Academy of Neurology guidelines, which of the following diagnostic tests should be included in the routine evaluation of the demented patient?
A 21-year-old female was admitted to the hospital with a 3 weeks history of progressive lower extremity weakness. An EMG was performed and the results were shown below. Based on the clinical history, examination, and diagnostic testing, the patient was started on plasma exchange (PLEX) therapy. After completing her PLEX therapy there was a marked improvement in her weakness. Although not shown below, which of the following additional NCS/EMG results were also likely present on the day of recording?
This muscle biopsy is most consistent with which myopathic disease?
A 63-year-old woman with a history of right-sided breast cancer status post-mastectomy, chemotherapy, and radiation presents to your clinic with a 2 months history of right arm pain and paresthesias. Which of the following findings on EMG/NCS would most likely suggest a radiation-induced plexopathy over a recurrent neoplastic plexopathy?