It's All In Your Head
A 65-year-old presents with unilateral resting tremor, bradykinesia, and REM sleep behavior disorder years before motor symptoms.
What is Parkinson's Disease?
Right facial droop and right arm weakness greater than right leg weakness suggest infarction in this vascular territory.
What is the left MCA?
A 62-year-old presents with sudden dizziness and imbalance for 2 hours, no limb weakness, but subtle right-sided ataxia. NIHSS is 1. Non-contrast CT is normal.
What is MRI with diffusion-weighted imaging?; it is indicated to detect acute posterior circulation infarcts that CT often misses
45-year-old with new severe headache different from prior migraines.
What is urgent; possible secondary headache (e.g., subarachnoid hemorrhage)?
A 28-year-old woman has fluctuating neurological deficits, including double vision one month, then numbness in the legs the next. MRI shows Dawson’s fingers.
What is Multiple Sclerosis?
Contralateral leg weakness greater than arm weakness points to this vascular territory.
What is the ACA?
A 29-year-old presents with transient episodes of unresponsiveness and lip-smacking, occurring once or twice per month. Routine EEG and MRI are normal.
What is prolonged video-EEG monitoring?; indicated to capture rare or focal seizure activity and localize seizure onset zones
19-year-old with epilepsy has a breakthrough seizure after missing medication; neuro exam normal.
What is non-urgent; breakthrough seizure in known epilepsy?
A 72-year-old presents with stepwise decline in cognition, urinary incontinence, and unsteady gait.
What is normal pressure hydrocephalus?
Contralateral hemianopia with macular sparing occurs with infarction in this artery.
What is the PCA?
A 57-year-old presents with gradual hand clumsiness and frequent tripping, and exam shows brisk reflexes in the legs but no sensory loss.
What is cervical spine MRI; indicated to detect spinal cord compression from disc herniation, spondylosis, or other structural lesions that may explain upper motor neuron signs?
70-year-old with jaw claudication, scalp tenderness, acute vision loss.
What is urgent; giant cell arteritis?
Recurrent brief, shock-like facial pains triggered by light touch or chewing localize to this condition.
What is trigeminal neuralgia?
Dysphagia, hoarseness, and loss of pain/temperature sensation on one side of the face and opposite body occur with this classic syndrome.
What is lateral medullary (Wallenberg) syndrome?
A 32-year-old woman has intermittent numbness and weakness in her leg and occasional blurred vision. Brain MRI shows small periventricular white matter lesions of unclear significance. This test with the associated finding can confirm the diagnosis (name the test and the finding).
What is a lumbar puncture showing oligoclonal bands?
A 29-year-old presents with sudden-onset bilateral lower limb weakness and numbness, along with loss of bowel control. Sensory level is noted at T10. No fever or trauma.
What is urgent; likely acute spinal cord compression (e.g., tumor, epidural hematoma, or abscess)?
A patient presents with acute ascending paralysis after a diarrheal illness. Nerve conduction shows demyelination.
What is Guillian-Barre Syndrome?
Pure motor hemiparesis without cortical signs suggests involvement of this structure.
What is the internal capsule (lacunar stroke)?
A 45-year-old secretary reports gradual numbness and tingling in the thumb, index, and middle fingers, worse at night. She occasionally drops objects. Phalen and Tinel signs are positive, but strength is preserved.
What are EMG and nerve conduction studies?
A 62-year-old presents with acute-onset confusion, visual hallucinations, and fever. Vitals show mild hypertension. Neurologic exam reveals neck stiffness and mild right-sided pronator drift. Brain MRI shows asymmetric T2/FLAIR hyperintensity in the medial temporal lobes.
What is urgent; likely herpes simplex virus (HSV) encephalitis?