Reference no: EM133394237
Case Study
A 65-year-old man presents to a neurologist complaining of a resting tremor. He is accompanied by his wife, who points out that her husband has been moving much more slowly, has not been sleeping well, and has been depressed and anxious. During the interview, the patient speaks in a low tone without facial expression, and his left hand has a resting tremor involving the fingers and wrist. Physical examination reveals a wide-based, shuffling gait without arm swing. Passive movement of the arms demonstrates uniform resistance to movement with a ratchet-like quality. Vital signs: Temperature = 37°C; HR = 90/min; and BP = 140/85 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
A 56-year-old man is brought to the ED by a coworker after suffering from severe headache, nausea, and vomiting over the past 2 hours. The patient was sitting at his desk when he suddenly developed a knifelike headache that he states is "10 out of 10" in intensity. He has never had a headache like this before. Shortly after headache onset, the patient became nauseous and vomited a few times before insisting that he be brought to the ED. On presentation to the ED, the patient is increasingly drowsy and is having difficulty answering questions. He denies any recent illness, head trauma, or history of migraine. He smokes one pack of cigarettes per day but denies any alcohol or intravenous drug abuse. Vital signs: Temperature = 37°C; HR = 86/min; RR = 14/min; and BP = 126/60 mm Hg. The patient has no back or neck pain. WBC, blood chemistry, and coagulation laboratory values are all within normal limits. His neurologic examination is notable for a sluggishly responsive pupil on the right.
Questions
What is the most likely diagnosis?
What is the etiology of this condition?
What are the clinical manifestations of this condition?
Case Study
A 78-year-old woman is found by her son lying at the bottom of the stairs in their house where they live together. After calling for an ambulance, the patient is brought to the ED for further evaluation. The son is not sure how long his mother was at the bottom of the stairs, but suspects that she must have fallen while attempting to descend the stairs. He states that she does not smoke or drink, and that she is fairly healthy except for a history of hypertension, for which she takes atenolol, and hip arthritis, for which she takes ibuprofen. The patient is unresponsive except to painful stimuli. The right pupil is 4 mm and sluggishly reactive, and the left pupil is 3 mm and reactive to 2 mm. Painful stimulation of the right lower and upper extremities elicits movement, whereas painful stimulation of the left produces no response. A Babinski reflex test elicits downgoing toes on the right and upgoing toes on the left. Vital signs: Temperature = 37°C; HR = 90/min; RR = 16/min; and BP = 135/75 mm Hg. CBC and blood chemistry values are within normal limits. The patient undergoes a noncontrast CT scan of the head, the results of which are shown below.
Questions
What is the most likely diagnosis?
What is the etiology of this condition?
What are the clinical manifestations of this condition?