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You are caring for a patient in the Neuro ICU for loss of consciousness after 3 convulsive episodes within a 2 hour period. She required intubation with rocuronium and sedation with propofol. She was loaded with 2000 mg of Keppra and had received 2 mg of Ativan in the ED. You obtain a spot EEG and left temporal epileptiform discharges are seen, but no additional seizures. Unfortunately, your hospital does not have continuous EEG capabilities. Of the following options, which physical exam change in this paralyzed patient is most likely to indicate potential repeat seizure and prompt stat repeat spot EEG and consideration of antiepileptic bolus?
A previously healthy two-year-old girl is brought to the clinic by her parents due to a 1-month history of difficulty walking. Her parents state that she began walking at 11 months old, but over the past month she has been falling more often. On physical exam, the patient demonstrates a broad-based gait and truncal ataxia. A CT scan of the brain is ordered and shows an intraparenchymal hyperdense mass in the cerebellum. She undergoes resection of the mass and a pathologic examination of the specimen shows anaplastic small round blue cells. What is the most likely diagnosis?
The pathologic findings marked by the blue arrows in the image below are most likely which of the following?
A patient with an unclear history of epilepsy has an EEG performed. Based on the region of her epileptiform activity, what is the most likely semiology of her clinical seizures?
A 45-year-old man with a past medical history of cardiac arrhythmia requiring pacemaker placement is referred to the clinic with a twenty-five-year history of slowly-progressive bilateral ptosis and diplopia. On examination, he has bilateral ptosis, decreased range of motion of the extraocular muscles, and mild proximal weakness in his upper and lower extremities. Which of the following is the most likely diagnosis?
Which of the following symptoms is atypical for essential tremor?
The ophthalmic branch of the trigeminal nerve exits the skull from which cranial foramina?
A patient presents to the emergency room with sudden onset weakness and dysphagia. On exam, the patient’s tongue deviates to the left, and there is right hemiparesis and right-sided loss of position and vibratory sensation. Pain and temperature sensation is intact. Which of the following arteries supplies blood to the damaged area?
A 41-year-old male presents to the emergency room with a two-day history of neck pain and speech difficulties. CT head shows scattered hypodensities in the left ACA and MCA territories. His Sagittal CT angiogram of the neck is shown below. What is the most likely cause of the patient’s symptoms?
Which of the following is the mechanism of action for natalizumab?
The following gross pathologic coronal section is presented to you for evaluation. The area shown by the black arrow is a sign indicative of which of the following disorders?
Which of the following is the most common cause of focal clonic seizures in full-term neonates?
A 10-year-old girl is brought to the clinic with a 1-month history of progressive clumsiness. Neurological examination shows significant bilateral ataxia. Imaging was performed and showed a midline lesion in the 4th ventricle. A biopsy was performed and shown below. Based on the most likely diagnosis, what is the most appropriate treatment plan?
A 39-year-old male presents with right-sided weakness and aphasia. NIHSS is 22 on physical exam. He was last known well 2.5 hours prior. The past medical history does not reveal any contraindications to tPA. A CT head is done and shows a hyperdense left MCA sign. The tPA is mixed by the nursing staff while you consent his wife for its administration. When you return to the bedside his aphasia has improved but his NIHSS is still 13. The blood pressure is 189/105 and the glucose is 225. What is the most appropriate next step?
A 54-year-old male with hypertension, hyperlipidemia, and atrial fibrillation on warfarin is newly diagnosed with epilepsy. Of the following medications, which is the most appropriate anti-seizure medication to prescribe?