[PDF] Top 20 Clinical Reasoning: A 52-year-old man with diplopia and ataxia

... On MRI, the dentate nuclei of the cerebellum and the pons are the most frequently involved sites and are usually contrast-enhancing. Lumbar puncture is help- ful for excluding alternative etiologies, but histiocytes are ... See full document

... gait ataxia (in the absence of sensory findings) also localizes to the ...Horizontal diplopia with distance vision that worsens on lateral gaze localizes to an ipsilateral lateral rectus ... See full document

... IV immunoglobulin (IVIg), plasmapheresis, and glucocorti- coids have historically been applied as treatment for MFS and BBE. Study of treatment effectiveness is limited to retro- spective research in a small number of ... See full document

... Returning to the case. Disease-modifying therapy was not instituted and the patient was followed with fre- quent clinical and MRI examinations. He remained clinically and radiologically stable for 2 years before ... See full document

... at risk for given that initial blood tests revealed a thrombo- cytopenia (platelets 114,000/mm 3 ; normal, 150–450). An EKG revealed normal sinus rhythm and a cardiac MRI 3 months prior revealed a preserved ejection ... See full document

... A 52-year-old woman was admitted to the hospital with a 3-week history of progressive gait instability with multiple falls and slurred ...headaches, diplopia, or ... See full document

... 27-year-old man with a history of diabetes mellitus (DM) and asthma presented to the emergency depart- ment 1 month after the onset of dysarthria and ...denied diplopia, dysphagia, preceding ... See full document

... On examination, the patient was afebrile and had normal vital signs. He was thin and appeared chron- ically ill. There was no meningismus. The remainder of the general medical examination was unremark- able. On ... See full document

... fever, diplopia coupled with papilledema, and bilateral 6th nerve palsy) is most concerning for an infectious process, specifically meningitis complicated by dysfunctional CSF circulation resulting in elevated ... See full document

... the clinical presentation of orbital metastasis is variable, it often has an abrupt presentation with decreased vision, diplopia, proptosis, and a palpable mass, as in our ... See full document

... CT of chest, abdomen, and pelvis with and without contrast showed a large ovarian mass consistent with cys- tadenocarcinoma with likely regional lymph node metastases. The patient’s CA-125 was elevated at 86 (normal ... See full document

... Ataxia localizes to either cerebellar lobe, as well as the output pathway from the dentate nucleus. Fibers exit through the superior cerebellar peduncle and then decussate in the midbrain to reach the contralat- ... See full document

... The findings suggest a length-dependent, sensori- motor, symmetrical polyneuropathy with sensory ataxia. Lack of upper motor neuron signs rules out cord pathology such as transverse myelitis. Diabetes is the most ... See full document

... The differential diagnosis for distortions of vision in terms of size (micropsia or macropsia), shape (meta- morphopsia), and color (dyschromatopsia) is broad and can localize to the orbit itself or alternatively to the ... See full document

... patient’s clinical stability, he was discharged under the care of his wife and went on to establish care at a facility near his home in another metropolitan ... 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

... Decompensated congenital fourth nerve palsy is also common and may present in adulthood. Charac- teristic features of congenital fourth nerve palsy in- clude head tilt, inferior oblique overaction, large vertical ... See full document

... while ataxia, anemia, and weight loss should prompt consid- eration of a paraneoplastic process, neurologic manifes- tations of malabsorption should also be ...sensory ataxia. Third, our case demonstrates ... See full document

... in Clinical Science and receives funding from Parkinson’s UK, the MRC Transla- tional Muscle Centre, and the UK NIHR Biomedical Research Centre in Ageing and Age-related ... See full document

... An 18-year-old Hmong man sought medical care because of worsening performance on military train- ing exercises. He had a previous syncopal episode with prompt recovery. His medical and developmen- ... See full document