Case Studies

Question 1

55 yo male cc “foot drop”. weakness started 6 mon ago progressively worse, now involves thigh muscles of same limb.
Normal PE/Mental exam/ Sensory INTACT
CN2-12 shows slight dysarthria and furrowed tongue
Upgoing toe = +Babinski
HYPERREFLEXIVE

Answer 1

Amyotrophic lateral sclerosis (ALS) - crawls along spinal cord cephalad

Question 2

Symmetric muscle weakness, sensory INTACT, increased CPK, HYPOREFLEXIVE

Answer 2

Polymyositis

Question 3

Diplopia, ptosis, fatigue, extremity weakness is profound in neck flexors and proximal. Hallmark: first eye drop, double vision, can’t swallow. picks on midline first. NORMOREFLEXIVE.
weak, painless, sensory normal

Answer 3

Myasthenia Gravis

Question 4

Which Nervous system (CNS or PNS) produces Hyperreflxive responses and which produces Hyporeflexive?

Answer 4

HYPER - CNS

HYPO - PNS

Question 5

A child pre teen (5-12) is noted to have blank spells (staring) and no memory of the event. Pt remains awake but unable to interact. no aura.
MRI neg
EEG - 3hz spikes and slow wave discharge
Ethosuximide is prescribe with Excellent results.
What does this child have?

Answer 5

Juvenile Absence Epilepsy

Question 6

A child (age 3-12) is noted to have episodes of brief muscle jerks (which he has amnesia for) esp when drowsy and occasional brief clonic seizures.
MRI neg
EEG shows a centro temporal spike with drowsiness

Answer 6

Benign Rolandic Epilepsy
age 3-12 issue brought on by sleep
no meds need child will grow out of problem

Question 7

75 yo pt w/ prior hx of stroke notices foul smell then has a sense of nausea increasing from the stomach. Shortly after he falls and has tonic extension of limbs, then clonic shaking of limbs with bladder incontinence and biting of the side of his tongue. Cyanosis is noted followed by rapid breathing and awakening to a confused state

Answer 7

Focal seizure after stoke is common.
CT shows encephalomalacia
EEG shows phase reversing spike focus ipsilateral to the CVA

Question 8

21 yo insulin dependent diabetic arrives in ED w/ hx clonic seizure.
CT neg
EEG pending
EKG tacky low BP
Lab - Glucose 35 urine ketones ++++

Answer 8

Hypoglycemic event assoc w/ excess insulin
this is a provoked seizure

*whenever giving glucose to an unconscious pt give 100mg thiamine first .

Question 9

50 yo increasing gait instability and c/o muscle feeling stiff
Exam normal, IQ normal
Sensory INTACT, DTR normal
Emotionless (bradykinesia)
Rx trial (Sinemet) resolved symptoms

Answer 9

Parkinson’s

dementia and dysautonomia comes late in dz

Question 10

80 yo w/ marked progressive (

Answer 10

Cortical Basilar Degeneration

Marked unilateral sx, rapid, refractory to Rx in older age onset
no tx available

Question 11

21 yo w/ personality changes over 1 year and c/o involuntary movements. Father committed suicide but had progressive personality changes before.
Exam - chorea in UE, mood irritable and apathetic w/ mild cognitive slowing

Answer 11

Huntington’s Chorea

Early onset of personality changes, movement disorder w/ family hx

Question 12

60 yo presents w/ rapid progressive gait instability
Exam: mild asymmetric muscle rigidity bradykinesia, nl DTR, nl sensory, no dementia.
Rx trial (Sinemet) did not work

Answer 12

MSA-p : Multiple system atrophy type P

rapid, refractory to meds, minimal dementia