50-year-old woman comes to the physician with her husband because of a 6-month history of progressive weakness of her arms and legs Neurologic examination shows mild spasticity, weakness, and hyperreflexia of the upper and lower extremities A Babinski sign is present bilaterally. An MRI of the spine shows a 1.5-cm, well-defined spherical lesion indenting the cervical spinal cord on the left of the C1 level Which of the following is the most likely diagnosis? Arteriovenous malformation Astrocytoma Epidural abscess Horniated disc Meningioma
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Step 1: Identify the pattern of presentation - Progressive weakness with upper motor neuron signs (spasticity, hyperreflexia, Babinski) suggests involvement of the spinal cord (cervical region in this case). Show more…
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CRITICAL THINKING SCENARIO: DIAGNOSE THE PATIENT A 30-year-old female comes to you with complaints of occasional tingling and numbness throughout her upper and lower extremities. She has been experiencing this over the last 6 months. She has recently experienced double vision and noticed she was getting weaker. She has been under extreme emotional stress lately. Initial Examination Vitals Patient Reference Range Pulse ox 96% >95% Respiratory rate 17 bpm 12 to 20 bpm Blood pressure 118/70 mmHg <120/80 mmHg Heart rate 70 bpm 60-100 bpm Physical Examination Skin appearance: normal Neurological Examination Elevated reflexes Pupils symmetrical in response to light Muscle Strength Testing Both upper and lower extremities demonstrate global weakness 1. Which of the diagnoses fits this patient's clinical presentation? Explain why the others are not the correct diagnosis. a. The patient is having a cerebral vascular accident (Stroke). b. Herniated disc at the level of the upper cervical spine. c. Multiple sclerosis (Autoimmune disease of the central nervous system).
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A 71-year-old woman was referred to the neurologist with 10 months of progressive gait difficulty, right leg numbness, and urinary problems. The patient was in good health, walking 3-4miles per day until about 10 months prior to admission, when she first noticed her mild gait unsteadiness and bilateral leg stiffness. She felt her feet were not fully under control. Her left leg gradually became weaker than her right, with occasional left leg buckling when she walked. Meanwhile her right leg developed progressive numbness and tingling, and she had intermittent left-sided thoracic back pain. Finally, she had increased urinary frequency, occasional urinary incontinence and difficulty completing a bowel movement despite several laxatives. Physical test: unremarkable apart from her rectal sphincter could not voluntarily contract. Neurologic test: Alert and oriented, mildly anxious but otherwise normal. Cranial nerves tested without any abnormalities Motor test of the upper extremities unremarkable. Lower extremities: normal muscle mass, tone increased in left leg, 5/5 strength throughout except for 4/5 in the left iliopsoas muscle. Reflexes are increased in the left leg, positive Babinski sign. Gait – Stiff-legged and unsteady Sensory test showed decreased pinprick sensation on the right side below the umbilicus. Vibration and joint position decreased on the left foot and leg. Otherwise, intact. Explain the anatomy and pathophysiology of the key symptoms listed below. Briefly describe the main pathways/tracts affected and their function (24 marks total) left leg weakness, increased tone, hyperreflexia, and Babinski’s sign (4 marks) decreased vibration and joint position sense in the left foot and leg (4 marks) decreased pinprick sensation on the right side below umbilicus, with right leg numb, tingling paraesthesia (4 marks) left-sided thoracic back pain level (4 marks) stiff-legged unsteady gait (4 marks) impaired bowel and bladder function (4 marks) What is the condition? Locate the lesion (3 marks) Suggest three possible causes (3 marks total, 1 mark for each suggestion)
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A 56 year old woman visited her family doctor for evaluation of a headache that had persisted for nearly a month. Upon questioning the patient, the doctor learned that her left arm, as she put it, "was a bit unwieldy, hard to control and weak." Through examination, the doctor determined that the entire left upper extremity was generally weak. He also found weakness, although less significant, of the left lower extremity. Sensation in the limbs seemed to be normal, although mild rigidity and hyperactive reflexes were present. Expressing concern, the doctor told the patient that she needed a CT scan of her head and explained that there could be a problem within the brain, possibly a tumor or other lesion. The doctor then picked up the phone and contacted a radiologist. After explaining the patient's case, the doctor remarked parenthetically that he believed he knew where the problem was located. 1) Why did the doctor suggest to the patient that there might be a problem within her brain when the symptoms were weakness of the extremities, and then just on one side of her body? 2) How would he know the location of the suspected brain tumor? 3) In which side of the brain and in which lobe would it be? 4) Explain the muscle weakness in terms of neuronal pathways from the brain to the periphery.
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