[PDF] Top 20 Clinical Reasoning: Progressive visuospatial problems in a 71-year-old man

... Examination revealed marked visuospatial dysfunc- tion and simultanagnosia. The patient was able to read when presented with one line of text, but unable to read a paragraph. Object recognition was preserved; ... See full document

... Rapidly progressive dementia is cognitive decline occurring over a period of weeks to months compared to the relatively slow cognitive decline over several years seen in neurodegenerative diseases such as Alz- ... See full document

... The MRI showed areas of restricted diffusion in the bilateral thalamus on DWI with a correlate in ADC imaging. These thalamic lesions also appeared hyperintense on FLAIR im- aging but did not enhance with contrast. ... See full document

... the clinical presentation or the progression over the ensuing days is atypical for AIDP—it is essential to repeat electrophysiologic studies in order to help inform decisions around investigation and treatment, ... See full document

... Treatment of autoimmune dementia with immunotherapy including IV methylprednisolone or IVIG has been reported. 7 Our patient received a 5-day course of IV methylprednisolone with an immediate improvement in cognition. ... See full document

... Evaluation for these conditions in this patient was negative. In addition, his clinical improvement on IVIg alone is inconsistent with an infectious or malignant process. Lumbar puncture was repeated ap- ... See full document

... AMN, which is often misdiagnosed as MS, HSP, or PLS, presents in adults (second to fourth decade of life) as a slowly progressive spastic paraparesis syndrome, with sensory and sphincter disturbances, and impo- ... See full document

... Freezing of gait is associated with parkinsonism. It can occur in idiopathic Parkinson disease (PD), atypical parkinsonian syndromes such as multiple system atrophy (MSA, which may also be associated with cerebellar ... See full document

... This patient presented with progressive symmetrical dis- tal lower limb weakness with electrophysiologic evidence of a progressive axonal sensorimotor polyneuropathy. CSF analysis suggested an inflammatory ... See full document

... right-handed man with a history of hypertension and hyperlipidemia presented with an 18-month history of diplopia and unsteady ...a year, his balance worsened to the point where he required a walker due to ... See full document

... the clinical presentation of stridor in the setting of progressive parkinsonism and ataxia in our patient, with MRI findings of olivopontocerebellar atrophy, was highly suggestive of a diagnosis of ... See full document

... Treatment of pituitary apoplexy involves medical and surgical management. Medical management includes monitoring vital signs, administering IV corticosteroids to prevent an Addi- sonian crisis, and checking laboratory ... See full document

... In combination with focal neurologic deficits, evidence of inflammation, such as contrast- enhancing lesions on MRI or CSF pleocytosis ($5 nucleated cells/mL) characterize brainstem encephalitis. In considering the ... See full document

... rapidly progressive dementia; (2) at least 2 of the following 4 clinical features: myoc- lonus, visual or cerebellar signs, pyramidal/extrapyra- midal signs, and akinetic mutism; (3) a positive result on ... See full document

... A 38-year-old man developed hypoxemia following an elective right heart catheterization. He was being evaluated for pulmonary hypertension. The hypoxe- mia improved with oxygen supplementation, and ... See full document

... the clinical picture can give additional information to get to a final ...the clinical picture, the condition would keep worsening and the MRI, CSF, or EEG would reveal specific changes, as would happen in ... See full document

... 56-year-old man presented with progressive neuro- logic symptoms that developed more than 14 years ...slowly progressive lower extremity weakness, increase in tone, and ... See full document

... An 18-year-old man presented to the emergency department after 3 weeks of intermittent headaches. He had experienced dull episodic central-parietal pain occurring 1 to 2 times a day and lasting for ... See full document

... 58-year-old man developed progressive walking dif- ficulty over 10 ...developed progressive gait unsteadiness, slurred speech, and swallowing ... See full document

... A 30-year-old man who recently immigrated from Liberia was admitted to the neurology service for dif- fuse weakness. He reported 7 years of painless pro- gressive weakness and atrophy. He noted that ... See full document