[PDF] Top 20 Clinical Reasoning: A 30-year-old man with headache and sleep disturbance

... Our patient was diagnosed with anti-Ma-2-associated en- cephalitis in the setting of a mediastinal germ cell tumor. He was continued on prednisone and initiated on che- motherapy with cisplatin, etoposide, and bleomycin. ... See full document

... healthy man presented to an ophthalmology clinic with binocular horizontal ...severe headache with associated fever, emesis, photo- phobia, phonophobia, and neck ... See full document

... On hospital day 3, the patient developed weakness and myo- clonic jerks of his right arm. Repeat EEG showed multiple focal seizures localized to his left centroparietal region. Oxcarbaze- pine was added without effect. On ... See full document

... clap headache, visual deterioration, ophthalmoplegia, signs of meningeal irritation, alteration in conscious- ness, and hormone dysfunction, became another important ... See full document

... A 30-year-old man presented with acute onset of lower back and leg pains followed by appearance of weakness in legs in December 2016. The weakness progressed over 1 hour to complete inability ... See full document

... 47-year-old man presented with a 5-year history of slowly progressive gait disorder with clumsiness and unsteadiness during walking, as well as stiffness and cramping pain in his ...1 ... See full document

... Levamisole-associated multifocal inflammatory leukoence- phalopathy (MIL) has been described in several case series with levamisole use for the aforementioned clinical purposes 2–4 and may present with subacute ... See full document

... Examination revealed intact mental status includ- ing orientation, attention, language, 3-word recall at 5 minutes, long-term memory, calculations, abstract reasoning, and praxis. The patient had equal and reac- ... See full document

... The selective paresis of the bilateral vocal cords that occurred only during sleep is a unique feature to this case. This would argue against an acute process such as ischemia, demyelination, or toxic exposure, ... 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

... A 39-year-old lawyer presented with intermittent spasms and pain in his abdominal muscles, particu- larly the right upper quadrant. These had occurred since his mid-20s and there had been long asymp- ... See full document

... riocarcinomas are rare and may originate from fetal trophoblasts or germ cells in the testes or ovaries. They account for about 1% of all testicular carcinomas. It is more common to see this subset of tumors in young ... See full document

... A 57-year-old man presented with spasms of his left jaw. Two years prior, he had developed left-sided facial numb- ness followed by development of left-sided shock-like pain and then involuntary and ... See full document

... Dr. Minen, A. Rodman, Dr. Foreman, and Dr. Motiwala report no dis- closures. Dr. Pullman serves on scientific boards for Musicians with Dystonia and the Dystonia Medical Research Foundation; serves on the editorial ... See full document

... Back to the case. The patient recovered fully over sev- eral months. Approximately 1 year after his initial pre- sentation, he returned with subacute headache, confusion, aphasia, diplopia, and unsteady ... See full document

... In some studies, 60%–80% of cases of apoplexy have no clear precipitant. 4 The most common precipitating factors include major surgery, clotting disorders, estrogen therapy, dopamine agonist therapy, head trauma, ... See full document

... 50-year-old man with a medical history of “ ele- phantiasis ” of the legs, status post left above the knee amputation with prosthetic limb, and hypothyroid- ism presented with 1 week of ... See full document

... The symptoms of headache, nausea, projectile vomiting, and papilledema could be explained by increased intracranial pres- sure. Neck stiffness indicates involvement of the meninges, and seizures suggest cortex ... See full document

... ever, similar cases have been reported in the pediatric population. e72e12 In these reports, the patients pre- sented with elevated ICP that improved after treat- ment of Lyme and were described as pseudotumor cerebri ... See full document

... noglobulin level favor TTR amyloid neuropathy. Other causes of hereditary amyloid neuropathy are ruled out because of the clinical features. For in- stance, gelsolin amyloidosis typically manifests with lattice ... See full document