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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?
Which of the following is the most accurate statement regarding driving with epilepsy?
A 12-year-old boy with no significant past medical history is admitted to the neurology service after presenting with acute-onset fever, personality changes, and difficulties with speech. His mother states that three days ago he also reported seeing bats and other wild animals running around his room. She decided to bring him to the hospital today after she noticed that he seemed more tired and was moving slower than normal. A lumbar puncture and MRI of the brain are ordered. The CSF shows elevated protein, elevated lymphocyte and red blood cell counts, and normal glucose. MRI of the brain is shown below. What is the most likely diagnosis?
A 65-year-old male is referred to the EMG lab with a recent right leg injury and associated weakness. Based on the EMG shown below, where is the most likely site of neuronal injury?
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 69-year-old male presents to the clinic with his wife who states that for the past 10 months the patient has become increasingly slow and more clumsy with daily activities. He has also been complaining of dizziness, especially in the morning when he first gets out of bed and has fallen once in the past month. On physical exam, it is observed that the patient has a 21 mmHg drop in systolic blood pressure when going from a sitting to a standing position. A brain MRI is ordered and shows a cruciform hypointensity in the pons. What is the most likely diagnosis?
A 19-year-old male with a history of a motorcycle accident 6 weeks ago with several bone fractures of the arms and legs was referred to the EMG lab with right arm numbness since the accident. Where is the most likely site of this patient’s neuronal injury?
A 19-year-old male presents to the ED during finals week of college after he had witnessed generalized convulsive activity on the floor of his dorm room. He has since returned to baseline. He states he has never had shaking like this before, other than when he wakes in the morning he’ll get an occasional twitch or two. An EEG is performed as below. Which is the treatment of choice?
A 25-year-old female with no significant past medical history presents with a two-day history of progressive bilateral lower extremity weakness and numbness. On physical exam, she has 3/5 strength in hip flexion and knee extension bilaterally, along with a loss of sensation. She is up to date on all vaccinations. She is afebrile. Sagittal (left) and axial (right) T2 thoracic MRI images are shown below. Which of the following is the most likely diagnosis?
A 67-year-old male with a gait disorder is having a polysomnogram due to aggressive leg movements during sleep. During the study, an abnormality is noted during sleep. The EMG and chin leads show excessive muscle artifact during sleep, while at the same time the EEG shows quick deflections in the lateral leads, indicating rapid alternating eye movements. He is given a diagnosis and started on medication. Which of the following is the most appropriate treatment for this sleep issue?
A lesion to which of the following neuroanatomical structures causes dysphagia, decreased gag reflex, and hoarseness?
How long ago did the ischemic injury seen on this neuronal tissue micropathology slide occur?
A 47-year-old female presents to the clinic with the chief complaint of slowly progressive proximal muscle weakness. Electromyography showed short duration, low amplitude motor unit action potentials. A muscle biopsy was performed and shown below. A diagnosis is made and the patient is started on a therapeutic agent. What is the most likely medication initiated?
A 50-year-old Caucasian woman with no past medical history is admitted to the psychiatric hospital after trying to jump from a moving bus. She reports the other passengers were laughing at her in their minds, and trying to steal her thoughts. Upon arrival to the psychiatric floor, she is witnessed to have sudden left eye deviation with right arm twitching for a few seconds before turning her head, screaming loudly, and falling to the floor with full-body convulsions, lasting 2 minutes.
You, the attending neurologist, are consulted to help evaluate. On exam she is easily distractible, looking to the corners of the room for security cameras. You contact her husband who states she has never had any problems like this before, but she has gone downhill over the last 3 weeks, forgetting people and places, repeating herself, and acting strangely.
Lab evaluation reveals normal CBC, BMP, TSH, T4, free T4, and T3. The comprehensive drug screen is negative. MRI brain w/ and w/o contrast is normal appearing. Lumbar puncture is with 18 cmH20 opening pressure, 0 WBCs, 1 RBC, 50 protein, and 55 glucose. The autoimmune panel is sent and anti-microsomal antibodies are elevated. What is the most likely diagnosis at this time?