[PDF] Top 20 Clinical Reasoning: An 18-year-old man with progressive headache and visual loss

... 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 ... See full document

... and progressive worsening, both motor and cognitive, prion diseases (either sporadic or familial: Creutzfeldt-Jakob disease, Gerstmann-Sträussler- Scheinker syndrome, and fatal familial insomnia) would be on top ... See full document

... (ICP). Headache is a common, nonspecific pre- senting symptom of increased ICP, often accompanied by additional alarming symptoms such as depressed level of consciousness, confusion, agitation, nausea, and ... See full document

... 20-year-old man presented to the emergency department with 1 week of headaches and double vision following 2 days of fever (102 8 F), nausea, and ...His headache was progressively wors- ening, ... See full document

... Progressive headache and cognitive decline with no focal signs beyond isolated anisocoria suggest altera- tion in intracranial pressure. The predominant cog- nitive symptoms and signs could suggest the ... 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

... right-handed man presented to the emergency room of our institution with the chief complaint of cognitive impairment of recent ...weight loss, and visual impairment (possible right homonymous ... See full document

... Although in some cases steroids have been used, clinical and radiologic features of methotrexate toxicity can fully resolve simply following drug withdrawal. In our patient, we discontinued methotrexate ... See full document

... 64-year-old man was referred with a 5-month history of progressive muscle ...The progressive severity of his weak- ness led him to require a wheelchair by the time of his ...denied ... See full document

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

... Binocular visual disturbances are more likely to localize to the occipital cortex than the bilateral orbits; possible disease processes affecting the occipital cortex in this case include occipital seiz- ures, ... See full document

... A 28-year-old man with sickle cell disease presented with 7 months of difficulty walking. Initial examination 3 months prior to admission to our hospital was thought to be consistent with a ... See full document

... 22-year-old man with no pertinent medical history presented to our emergency department with headaches, nausea, vomiting, and right leg ...throbbing headache that was 6/10 in severity ... 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 75-year-old man with hypertension and hyperlipide- mia presented with 3 years of progressive visual difficul- ties. Ophthalmologic evaluation revealed cataracts, but his vision was ... See full document

... weight loss). The age at onset and the clinical presentation may be compatible with an idiopathic form of Parkinson disease (PD) or an atypical parkin- sonism, including multiple system atrophy type P ... See full document

... 49-year-old man with a medical history significant for diabetes mellitus, a left thigh sarcoma that was resected 5 years prior, and a seizure disorder on valproic acid presented with 2 months of ... 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

... field loss. 7 In patients with severe/progressive impairment of vision, trans-sphenoidal surgery within 8 days results in significantly greater im- provement in visual acuity and fields than later ... See full document

... vealed increased left optic nerve enlargement, with extension into the chiasm and pathologic enhance- ment. At another institution, a presumptive diagno- sis of a left optic nerve glioma was made on the basis of ... See full document