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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?
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?
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?
A 35-year-old Dominican Republic immigrant is brought to the emergency room for a first-time seizure. He is currently back to baseline and has a normal neurological exam. His only complaint is a multiple-month history of chronic headaches. A head CT scan is performed and shown below. Which of the following is the most likely etiology of his symptoms?
A 57-year-old male with an unknown past medical history who recently immigrated from South Asia presents to the emergency department with new-onset skin lesions on his arms. On physical exam, the patient has two large, erythematous lesions with a clearly demarcated but flat border. The nerves around these lesions appear thickened. Biopsy of the lesions shows epithelioid cell granulomas and few bacteria. What is the most likely diagnosis?
A 37-year-old man with poorly controlled diabetes mellitus presents to the emergency department with a three-day history of progressive headache, fever, and double vision. Examination shows bilateral proptosis, peri-ocular erythema, and ophthalmoplegia. CT of the head was ordered and showed bony destruction of the sinuses. Based on the most likely diagnosis, which of the following is the most appropriate treatment?
A previously healthy 25-year-old female presents to the emergency room with lower extremity weakness, numbness, and urinary retention. Lower extremity hyperreflexia and a sensory level at T10 were appreciated on examination. A contrasted cervical/thoracic and lumbar MRI was performed and shown below. Lumbar puncture was performed after imaging was completed and showed an elevated protein concentration, normal glucose, 3 WBCs, and oligoclonal bands. Rheumatologic studies are negative. Based on the most likely diagnosis, what is the most appropriate next step in medical management?
What is the most appropriate therapy for the infection depicted in the pathology slide below?
A 56-year-old man with a history of a kidney transplant, on tacrolimus, presented to the hospital with a 2-week history of progressive confusion and expressive aphasia. An MRI brain with and without contrast was performed and shown below. A brain biopsy was performed and showed microglial nodules with encysted bradyzoites and tachyzoites. Which of the following is the most appropriate therapy?
What anatomical structure is the most common location for a Mycobacterium tuberculosis-related CNS infection?
This brain biopsy is consistent with which of the following pathologies?
A 42-year-old woman with multiple sclerosis presents to the ER after having worsening confusion over a few days with worsening weakness and vision loss. She was on natalizumab for years and her most recent JCV antibody titer was negative. She has missed several months of infusions due to her helping a sick relative. Her MRI shows multiple new T2 hyperintensities with enhancement in the periventricular and subcortical white matter. What is the most likely diagnosis?
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 12-day-old male is brought to the pediatrician by his mother with a two-day history of rash. The child was born full-term to a G2P2 mother with good APGAR scores. On physical exam, the pediatrician notes that the child has a pink, crusting, maculopapular rash over his buttocks, thighs, and soles of his feet. She states that a week after his birth he had the “sniffles” and a lot of white discharge from his nose. On exam, there is hepatomegaly and generalized lymphadenopathy. Which of the following is the most likely cause of the patient’s symptoms?
A 78-year-old man presents to the ER with headache, fever, diplopia, and hiccups. MRI with the brain with and without contrast shows small contrast-enhancing abscesses in the brainstem, sparing supratentorial cerebral tissue. Which of the following infectious agents classically presents in this fashion?
A patient recently diagnosed with multiple sclerosis was started on an oral disease-modifying therapy (DMT) that works on nuclear factor erythroid-derived 2-related factor (Nrf2)-dependent and independent pathways. One week later they call you complaining of flushing of the skin. What is the most appropriate next step in management?
Aquaporin-4 (AQP4) channels are found on which cell type?
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 4-month-old infant of Amish parents is evaluated in the emergency department for an acute onset of weakness, poor feeding, and irritability that started 2 days ago. Neurologic examination of the child was impressive for ptosis, decreased tone, generalized weakness, a poor suck reflex, and mydriasis. MRI of the brain was normal. Which of the following is the most likely cause of the patient’s symptoms?