neurology

A 70-year-old man presents to the emergency department with sudden onset of severe headache, nausea, and vomiting. He has a history of hypertension and is currently on antihypertensive medication. On examination, he is drowsy and has a blood pressure of 180/110 mmHg. A CT scan of the brain shows a hyperdense area in the right basal ganglia. What is the most likely diagnosis?

A 72-year-old woman with a history of well-controlled hypertension presents with sudden-onset headache and vomiting. Neurological exam reveals mild neck stiffness but is otherwise normal. A CT angiogram reveals a posterior communicating artery aneurysm, which was subsequently coiled. The image shows a post-coiling angiogram. 24 hours post-procedure, she develops worsening headache and new-onset right-sided weakness. What is the MOST appropriate next step?

A 72-year-old woman is admitted to the hospital with increasing confusion and generalized weakness over the past week. Her medical history includes hypertension, for which she takes hydrochlorothiazide 25mg daily. On examination, she is lethargic and disoriented. Her blood pressure is 110/70 mmHg, heart rate is 88 bpm, and respiratory rate is 16 breaths per minute. Neurological examination reveals decreased reflexes. Initial laboratory investigations reveal the following: Sodium: 118 mmol/L Potassium: 3.8 mmol/L Chloride: 85 mmol/L Bicarbonate: 24 mmol/L Blood Urea Nitrogen (BUN): 25 mg/dL Creatinine: 1.1 mg/dL Glucose: 95 mg/dL Urine osmolality is 600 mOsm/kg. Serum osmolality is 250 mOsm/kg. Which of the following is the most appropriate initial management strategy?

An old man presents with 6 months of memory decline, falls, visual hallucinations, agitation, and confusion. Which of the following features is relevant to diagnosing his condition?

A 67-year-old man with a history of type 2 diabetes mellitus and hypertension presents to the emergency department with sudden onset of right-sided weakness and slurred speech that began 2 hours ago. He has no history of atrial fibrillation or previous strokes. On examination, his blood pressure is 180/95 mmHg, heart rate is 88 bpm, and he is afebrile. Neurological examination reveals right-sided hemiparesis and expressive aphasia. A non-contrast CT scan of the head shows no evidence of hemorrhage. Which of the following is the most appropriate next step in the management of this patient?

A 68-year-old male presents with worsening headaches and blurred vision. He underwent endovascular coiling for a posterior cerebral artery aneurysm 6 months ago. The attached image was obtained. Which of the following is the MOST appropriate next step in management?

A 68-year-old woman with a history of hypertension presents with a severe headache and altered mental status. Aneurysm coiling was performed. The image shows a post-operative angiogram. 6 hours later, she develops a fever of 38.5°C and worsening neurological deficits. What is the MOST likely cause?

A 68-year-old woman presents with a 2-week history of progressive weakness in her right arm and leg, associated with a tremor in the right hand. She also reports feeling more tired than usual. Her general practitioner noted an elevated TSH (12 mIU/L, reference range 0.4-4.0 mIU/L) on routine blood tests done a month ago, but free T4 was within the normal range (15 pmol/L, reference range 10-20 pmol/L). On examination, she has mild right-sided hemiparesis (MRC grade 4/5) and a coarse tremor in the right hand, worse with action. Reflexes are brisk on the right. The rest of the neurological exam is unremarkable. She has mild bradycardia (55 bpm) but no other signs of overt hypothyroidism. What is the most appropriate initial investigation?

A 75-year-old obese man with a history of hypertension and chronic lower limb skin changes, swelling, tingling, and weakness presents with sudden onset inability to stand or move his legs, accompanied by a loss of sensation extending up to his waist. On examination, he has flaccid paralysis of both lower limbs, absent deep tendon reflexes in the legs, and a sensory level at the umbilicus. Which of the following is the most appropriate initial investigation?

A 25-year-old man presents to the emergency department with a 2-day history of severe headache, photophobia, and neck stiffness. He has no significant past medical history and is not on any medications. On examination, he is febrile with a temperature of 39°C, and there is a positive Brudzinski's sign. What is the most appropriate initial investigation to confirm the diagnosis?

A 62-year-old patient presented with a subarachnoid haemorrhage secondary to a ruptured cerebral aneurysm and underwent endovascular coiling. They have recovered well and are on routine follow-up. The image shows a recent angiogram performed as part of their surveillance. Considering the findings, what is the MOST appropriate next step in this patient's management?

A 68-year-old woman with a history of hypertension presents with a severe headache and altered mental status. Aneurysmal coiling was performed. The image shows a post-operative angiogram. 6 hours later, she develops a fever of 38.5°C and worsening confusion. What is the MOST appropriate next step?

A 65-year-old man with a 20-year history of poorly controlled type 2 diabetes mellitus, hypertension, and dyslipidaemia presents with a 6-month history of burning pain in his feet, worse at night, often waking him from sleep. He also reports feeling lightheaded when standing up quickly and has noticed difficulty initiating urination and a weak stream. On examination, his blood pressure is 135/85 mmHg supine and 115/70 mmHg after standing for 3 minutes. Neurological examination reveals decreased sensation to pinprick and light touch in a stocking distribution up to the mid-calf bilaterally. Vibration sense is reduced at the ankles. Ankle reflexes are absent. The remainder of the examination is unremarkable. His most recent HbA1c is 8.9%. Which of the following is the most likely underlying cause of his constellation of symptoms?

A 62-year-old man presents to the emergency department with sudden onset of severe headache, nausea, and vomiting. He has a history of poorly controlled hypertension and is currently on no medications. On examination, he is drowsy but arousable, with a blood pressure of 210/120 mmHg and a heart rate of 90 bpm. Neurological examination reveals right-sided hemiparesis and a left gaze preference. A CT scan of the head shows a large hyperdense area in the left basal ganglia with surrounding edema. What is the most appropriate initial management for this patient?

A 37-year-old lady presents with a sudden right-sided facial droop, with no ear symptoms or dysphagia. She is 16 weeks pregnant. What is the likely diagnosis?

A 65-year-old man undergoes successful coil embolization of a ruptured anterior communicating artery aneurysm. Two days post-procedure, he develops a temperature of 38.1°C, generalized malaise, and a headache unresponsive to paracetamol. Neurological exam is unchanged from baseline. CRP is 45 mg/L (normal <5). Which of the following is the most likely cause of his current symptoms?

A 68-year-old woman with a history of hypertension presents with a severe headache and altered mental status. Aneurysmal coiling was performed. The image shows a post-operative angiogram. 6 hours later, the patient's GCS decreases. What is the MOST likely cause?

A 68-year-old presents with worsening headaches post-aneurysm coiling. The image shows a follow-up angiogram. What is the MOST appropriate next step?

A 68-year-old woman with a history of hypertension and hyperlipidemia presents to the emergency department with a sudden onset of left-sided hemianopia and mild right-sided weakness. Her symptoms began approximately 4 hours prior to arrival. Initial neurological examination reveals intact language function and no cognitive deficits. A CT angiogram was performed, followed by endovascular coiling. The provided image shows a post-operative angiogram. Despite the intervention, the patient's hemianopia persists, and her weakness has slightly worsened. What is the MOST appropriate next step in the management of this patient?

A 55-year-old female presents with new onset right homonymous hemianopia 3 months post-aneurysm coiling. Review the image. What is the MOST likely cause?

A 72-year-old male with a history of hypertension presents with a sudden onset of right-sided weakness and expressive aphasia. He underwent endovascular coiling for a PCA aneurysm 1 year ago. The attached image was obtained. What is the MOST likely cause of his current presentation?

A 55-year-old patient presented with a subarachnoid haemorrhage from a ruptured cerebral aneurysm, which was successfully treated with endovascular coiling. They have made a good recovery. The image shows a routine follow-up angiogram performed 6 months post-procedure. Based on the findings demonstrated in the image, what is the MOST appropriate next step in this patient's management?

A 40-year-old man presents to the emergency department with sudden onset of severe headache, nausea, and vomiting. He describes the headache as the worst he has ever experienced. He has a history of hypertension but is otherwise healthy. On examination, he is alert but in distress, with a blood pressure of 180/110 mmHg, heart rate of 90 bpm, and respiratory rate of 18 breaths per minute. Neurological examination reveals neck stiffness but no focal neurological deficits. A CT scan of the head shows no acute intracranial hemorrhage. What is the most appropriate next step in the management of this patient?

A 68-year-old woman with a history of hypertension and hyperlipidemia presented to the emergency department with a sudden onset of left-sided hemianopia and mild right-sided weakness. Her symptoms began approximately 4 hours prior to arrival. Initial neurological examination revealed a left homonymous hemianopia, mild right hemiparesis (4/5 strength), and intact sensation. A CT angiogram was performed, identifying a cerebral aneurysm, and the patient subsequently underwent endovascular coiling. The provided image was obtained immediately following the procedure. Despite the intervention, the patient's left homonymous hemianopia persists, and her right hemiparesis has not improved. Considering the findings on the post-procedure imaging in the context of her ongoing neurological deficits, which of the following is the MOST appropriate immediate management step?

A 68-year-old man with hypertension presents with sudden onset right-sided weakness and slurred speech. GCS is 13. BP 190/110 mmHg. What is the most critical initial investigation to guide management?

A 67-year-old man presents to the emergency department with sudden onset of severe headache, nausea, and vomiting. He has a history of hypertension and is currently on amlodipine. On examination, he is drowsy but arousable, with a blood pressure of 210/120 mmHg and a heart rate of 90 bpm. Neurological examination reveals a left-sided hemiparesis and a right-sided facial droop. A CT scan of the head shows a hyperdense lesion in the right basal ganglia with surrounding edema. Which of the following is the most appropriate initial management step?

A 32-year-old woman presents to the emergency department with sudden onset of severe headache, nausea, and photophobia. She has no significant past medical history and is not on any medications. On examination, she is alert but in distress due to the headache. Her vital signs are stable, and there is no neck stiffness. A CT scan of the head is performed and shows no abnormalities. What is the most appropriate next step in the management of this patient?

An elderly man presents with a 6-month history of memory decline, recurrent falls, visual hallucinations, agitation, and confusion. His wife reports he talks to people who are not visible. Which of the following clinical features is most helpful in diagnosing his condition?

A patient is given an antiemetic and subsequently develops spasticity of the back. What is the most appropriate initial management?

A 60-year-old female with a history of a posterior cerebral artery aneurysm presents for routine follow-up. Review the image. What is the MOST appropriate management?

A 68-year-old woman with a history of hypertension and hyperlipidemia presents to the emergency department with a sudden onset of left-sided hemianopia and mild right-sided weakness. Her symptoms began approximately 4 hours prior to arrival. Initial neurological examination reveals intact language function and no cognitive deficits. A CT angiogram was performed, followed by endovascular coiling. The provided image shows a post-operative angiogram. Despite the intervention, the patient's hemianopia persists, and her weakness has slightly worsened. What is the MOST appropriate next step in the management of this patient?

A 72-year-old male with a history of atrial fibrillation and well-controlled hypertension presents with acute onset expressive aphasia and right-sided facial droop. A CT angiogram reveals a posterior cerebral artery aneurysm, which was promptly treated with endovascular coiling. The provided image shows the post-operative angiogram. Despite the intervention, the patient's aphasia persists, and the facial droop has worsened. What is the MOST likely cause of the patient's continued and worsening symptoms?

A 62-year-old woman presents to the emergency department with sudden onset of severe headache, nausea, and vomiting. She describes the headache as the worst she has ever experienced. Her medical history includes hypertension and hyperlipidemia, for which she is on regular medication. On examination, she is alert but in distress, with a blood pressure of 180/100 mmHg, heart rate of 90 bpm, and respiratory rate of 18 breaths per minute. Neurological examination reveals neck stiffness but no focal neurological deficits. A CT scan of the head shows no acute intracranial hemorrhage. Which of the following is the most appropriate next step in management?

A 72-year-old man presents to the emergency department with confusion and difficulty walking. His family reports that he has been increasingly forgetful over the past few months and has had several falls. He has a history of hypertension and hyperlipidemia, for which he takes lisinopril and atorvastatin. On examination, he is disoriented to time and place, with a blood pressure of 140/85 mmHg, heart rate of 78 bpm, and a wide-based gait. Neurological examination reveals brisk reflexes and a positive Romberg sign. A CT scan of the head shows mild cortical atrophy but no acute lesions. Which of the following is the most likely diagnosis?

A 30-year-old woman with bipolar disorder is prescribed risperidone for manic episodes. She develops tremors and rigidity. What is the most likely diagnosis?

A 55-year-old man with a 15-year history of type 2 diabetes presents with numbness and tingling in his feet. On examination, there is reduced sensation to light touch and vibration in a stocking distribution. What is the most appropriate initial management for his symptoms?

A 30-year-old woman presents to the emergency department with a 2-day history of fever, sore throat, and a diffuse rash. She recently started taking a new medication for her epilepsy. On examination, she is febrile at 38.2°C, with a heart rate of 100 bpm and blood pressure of 110/70 mmHg. The rash is erythematous and involves the trunk and extremities, with some areas of desquamation. Laboratory tests reveal leukocytosis with eosinophilia and elevated liver enzymes. Which of the following is the most likely diagnosis?

A 45-year-old man presents to the emergency department with sudden onset of severe headache, described as the worst headache of his life. He also reports nausea and photophobia. On examination, he is alert but in distress, with a blood pressure of 160/100 mmHg, heart rate of 90 bpm, and no focal neurological deficits. A CT scan of the head is performed and shows no acute intracranial hemorrhage. What is the most appropriate next step in management?

A 55-year-old patient presents with a subarachnoid haemorrhage from a ruptured posterior cerebral artery aneurysm. Endovascular coiling is performed without immediate complications. The image shows the post-procedure angiogram obtained before leaving the angiography suite. Based on this finding, what is the MOST appropriate next step in management?

A 68-year-old male presents with worsening headaches and blurred vision 3 months post-embolization. The attached image was obtained. Which of the following is the MOST appropriate next step in management?

A 68-year-old woman with a history of hypertension and hyperlipidemia presents to the emergency department with a sudden onset of left-sided hemianopia and mild right-sided weakness. Her symptoms began approximately 4 hours prior to arrival. Initial neurological examination reveals a left homonymous hemianopia, mild right hemiparesis (4/5 strength), and intact sensation. A CT angiogram was performed, and the patient underwent endovascular coiling. The image shows a follow-up angiogram post-procedure. Despite the intervention, the patient's left homonymous hemianopia persists, and her right hemiparesis has not improved. What is the MOST appropriate next step in the management of this patient?

A 68-year-old woman with a history of hypertension presents with a severe headache and altered mental status. Aneurysmal subarachnoid hemorrhage is confirmed. The aneurysm was coiled. The image shows a post-operative angiogram. 6 hours later, the patient's GCS decreases. What is the MOST likely cause?

A patient reports dizziness with neck extension. Which manoeuvre is most appropriate to assess for vertebrobasilar insufficiency?

Which of the following is a key feature that helps confirm the diagnosis of Serotonin Syndrome?

A 72-year-old woman with a history of well-controlled hypertension and type 2 diabetes presents to the emergency department with sudden onset of visual disturbance and mild weakness. She describes the visual issue as a loss of vision in the left half of her visual field, which began approximately 3 hours ago. She also notes some difficulty moving her right arm and leg, which started around the same time. On examination, her vital signs are stable: BP 135/85 mmHg, HR 78 bpm, RR 16/min, Temp 36.8°C, SpO2 98% on room air. Neurological examination confirms a left homonymous hemianopia and mild right hemiparesis (MRC grade 4/5) affecting both upper and lower limbs. Sensation is intact. Reflexes are symmetrical, and plantar responses are flexor. A non-contrast CT head was unremarkable for acute haemorrhage or established infarction. Subsequent CT angiography identified a cerebral aneurysm in a location consistent with her symptoms, and she was taken for endovascular coiling. The procedure was completed approximately 6 hours after symptom onset. The image provided is a digital subtraction angiogram obtained immediately following the coiling procedure. Despite the intervention, her left homonymous hemianopia and right hemiparesis persist without significant improvement. Considering the findings demonstrated in the post-procedure imaging in the context of her ongoing neurological deficits, which of the following is the MOST appropriate immediate management step?

A 24-year-old lady presents with worsening right eye 'ache' and reduced vision. The symptoms worsen with eye movements, and there is no redness or fluorescein uptake. Her vision is 6/12 in the right eye and 6/6 in the left eye. There is a relative afferent pupillary defect (RAPD) on examination. What associated disease could this indicate?

A 62-year-old woman presents to the emergency department with acute confusion and weakness on the right side of her body. She has a history of atrial fibrillation and is on warfarin for anticoagulation. Her INR is 3.5. On examination, she is disoriented to time and place, with a right-sided facial droop and hemiparesis. A CT scan of the head shows a left-sided intracerebral hemorrhage. What is the most appropriate next step in the management of this patient?