Reference no: EM133396563
Case Study 1
A 45-year-old man is brought to the emergency department following a generalized convulsive episode witnessed by strangers. He was subsequently observed to be in a confused state, having lost continence of bowel and bladder. When the paramedics bring him to the hospital, he is more lucid but his language ability seems impaired. He states that he has noticed progressive difficulty comprehending conversations, and that he sometimes mispronounces words or uses the wrong words. He says he has also been suffering from general malaise and a dull headache. In the past several weeks he has had several episodes of "lost time" in which he loses awareness, followed by a transient disorientation; he has no memory of what occurs during these episodes. The patient denies any fever, chills, night sweats, or recent illness and has no relevant past medical history. He smokes half a pack of cigarettes per day and drinks socially on occasion. On examination, the patient is well appearing and in no acute distress. His vital signs are stable and his CBC and blood chemistry studies are unremarkable.
Questions
What is the most likely diagnosis?
What is the etiology of this condition?
What are the clinical manifestations of this condition?
Case Study 2
A woman brings her 50-year-old father to a neurologist after being referred by his psychiatrist. He is belligerent, making inappropriate comments, and occasionally experiencing auditory hallucinations. His behavioral problems developed a few years ago and were initially attributed to a substance abuse problem. However, a recent examination by his psychiatrist showed rhythmic, repetitive grimacing and blinking, with occasional rapid, jerky, dancelike movements of his right arm. The daughter says that she remembers her grandfather having similar symptoms and that he died by suicide when she was a child. Vital signs: Temperature = 37°C; HR = 80/min; and BP = 145/90 mm Hg.
Questions
What is the most likely diagnosis?
What is the etiology of this condition?
What are the clinical manifestations of this condition?
Case Study 3
A 20-year-old college student presents to the clinic with fever and headache 2 days after returning from spring break in Florida. The headache began the night before and has significantly disrupted her routine. She describes it as a 10/10, nonpulsating headache, exacerbated by moving her neck. She also notes that loud noises and bright lights seem to bother her much more than usual. On physical examination, her temperature is 39.1°C, pulse is 112/min, and the respiratory rate is 14/min. She is unable to touch her chin to her chest, and she experiences significant pain upon flexion of her thigh with extension of her leg. There is a macular purple rash over both shins, which she had not noticed before. Her funduscopic exam is normal, and she has no focal neurologic deficits. A lumbar puncture (LP) reveals cloudy fluid and the following results: Protein: 5 g/L (elevated); Glucose: 3 mmol/L (decreased); WBC count: 1010/mm3 (elevated), Differential WBC: 98% neutrophils (elevated); RBCs: 5/mm3 (normal); Bacteria: none visualized.
Questions
What is the most likely diagnosis?
What is the etiology of this condition?
What are the clinical manifestations of this condition?