Neurology

Prioritization: Run This Board: Septic Shock, Acute Coronary Syndrome, Small Bowel Obstruction, and Penetrating Chest Trauma

Colleen Donovan, MD1, Nicole Novotny, MD2, Charles Lei, MD3, Alaa Aldalati, MBBS4, Andrew Melendez, DO5, Neil Wallace, MD6, Tiffany Moadel, MD7, Stephanie Stapleton, MD8 and Shagun Berry, DO9

DOI: https://doi.org/10.21980/J8.52355 Issue 10:5[mrp_rating_result]
By the end of this case learners will be able to: 1) Become familiar with format of a prioritization case (a component of the ABEM Certifying Exam), 2) Practice their ability to prioritize multiple patients and provide stabilizing care, 3) Consider changes in status/patient acuity/new cases as presented, 4) Understand how to utilize team resources appropriately.
Current IssueAbdominal/GastroenterologyCardiology/VascularCertifying Exam CasesClinical Decision-MakingInfectious DiseaseNeurologyOb/GynPediatricsPrioritizationTrauma

Prioritization: Intracranial Hemorrhage, Testicular Torsion, and Tricyclic Antidepressant Toxicity Presenting to a Community Emergency Department

Brian Milman, MD*, Marshall Howell, MD*, Joshua Ginsburg, MD* and Samuel Parnell, MD*

DOI: https://doi.org/10.21980/J8.52346 Issue 10:5[mrp_rating_result]
By the end of this case learners should: 1) Become familiar with the format of a prioritization case (a component of the ABEM Certifying Exam), 2) demonstrate their ability to prioritize multiple patients and provide stabilizing care, 3) consider changes in status/patient acuity/new cases as presented, 4) understand how to utilize team resources appropriately.
Current IssueCertifying Exam CasesNeurologyPrioritizationToxicologyTraumaUrology
Nonketotic Hyperglycemia Hemichorea. MRI Unnnotated. JETem 2025

Case Report of a Patient Presenting with Nonketotic Hyperglycemia Hemichorea

Jay Patel, DO*, Kayla Pena, MD*, Joshua Bucher, MD* and Amanda Esposito, MD*

DOI: https://doi.org/10.21980/J8.52115Issue 10:4[mrp_rating_result]
Laboratory tests indicated elevated blood glucose levels (198 mg/dL) with no urinary ketones, anion gap of 12, thyroid stimulating hormone (TSH) of 12 UIU/ml, and an increased glycated hemoglobin (HbA1c) of 14.9%. After initial stroke evaluation with neurology, imaging studies, including computed tomography (CT)/CT angiography (CTA) of the brain and neck, were unremarkable, ruling out structural lesions or acute stroke. Neurology recommended an MRI which showed T1 shortening within the left basal ganglia involving both the caudate nucleus and the lentiform nucleus. T1 shortening indicates changes in the tissue composition or structure that alters how the tissue responds to the MRI pulse, giving the tissue a brighter appearance on MRI (see white arrow).
Visual EMEndocrineNeurology

Posterior Reversible Encephalopathy Syndrome and Eclampsia

Kristina Jacomino, MD*, Kevin Tomecsek, MD*, Andrew Little, DO* and Mary Mclean, MD*

DOI: https://doi.org/10.21980/J8H64T Issue 10:3[mrp_rating_result]
At the end of this oral boards session, examinees will be able to: 1) demonstrate familiarity with the structured interview oral board format and case play; 2) recognize the history and exam features concerning for PRES and eclampsia; 3) order appropriate diagnostic workup for postpartum and hypertensive emergencies including eclampsia and PRES; 4) understand treatment options for the management of eclampsia (intravenous [IV] magnesium sulfate, IV antihypertensive therapy, and emergent consultation with an obstetrician [OB/GYN]); 5) understand threshold for taking control of airway in patients with eclampsia; 6) understand indications for ordering brain imaging in patients with eclampsia and altered mental status; and 7) demonstrate effective communication with treatment team/family members as well as correct disposition of the patient to a higher level of care (intensive care unit [ICU]).
Certifying Exam CasesNeurologyOb/Gyn
Mycoplasma Associated Acute Transverse Myelitis. MRI. Unannotated. JETem 2025

Beware of the Pediatric Limp: A Case of Mycoplasma Associated Acute Transverse Myelitis

Michael Neff, MD*, Nicholas Xie, MD^, Joseph Fong, MD† and Gregory Podolej, MD**

DOI: https://doi.org/10.21980/J8QQ1Q Issue 10:3[mrp_rating_result]
An MRI with contrast, T2 sequence was performed. In Figures a-d, the MRI of the patient’s brain and spinal cord on admission shows abnormal signals in the patient’s pons (lack of symmetrical gray-white differentiation on cross-section) along with hyperintensity (sagittally shown as brightness in what should be homogenously intense spinal cord) and significant central cord edema (with swelling seen as increased width) starting from C5 and continuing to the conus medullaris around L1/L2.
Visual EMNeurologyPediatrics
Myasthenia Gravis Eyes Taped Open. JETem 2025

Eye-Opener: A Case Report of Eyelid Taping as Presenting Symptom of Myasthenia Gravis

Mary G McGoldrick, MD* and Chirag N Shah, MD^

DOI: https://doi.org/10.21980/J8NW8G Issue 10:2[mrp_rating_result]
Physical exam was significant for a very pleasant, well-appearing female in no acute distress, noted to have clear plastic tape attached to her bilateral eyelids and brows (Image 1). When the tape was removed, she had bilateral ptosis, more significantly in the left eye (Image 2). She had no conjunctival injection or pallor. Her airway was patent and protected. She had no neck masses or carotid bruits. Her heart and lung exams were normal, with no evident respiratory distress. Her neurologic exam was further significant for limited extra-ocular movement (EOM). Her most notable deficits were with lateral and upward gaze (Video 1) indicative of weakness at the muscles innervated by cranial nerves III and VI. Her pupillary response was symmetric and brisk bilaterally. She had no additional cranial nerve deficits, slurred speech, or asymmetry in her strength or sensation throughout.
Visual EMNeurology

Subarachnoid Hemorrhage Causing a Seizure: An Assessment Simulation for Medical Students

Robert Rainer, MD*, Blair Creedle Reynolds, MD*, Cyrus Adeli^ and Christopher E San Miguel, MD, MEd*

DOI: https://doi.org/10.21980/J8XH1H Issue 9:3[mrp_rating_result]
At the conclusion of the simulation leaners will be able to: 1) efficiently take a history from the patient and perform a physical exam (including a complete neurological exam); 2) identify red flag symptoms in a patient complaining of a headache; 3) order and interpret the results of a CT of the head and either a CT angiogram of the brain or a lumbar puncture to make the diagnosis of subarachnoid hemorrhage; 4) demonstrate appropriate management of a seizure; and 5) utilize the I-PASS framework to communicate with the inpatient team during the transition of care.
NeurologySimulation
Internuclear Ophthalmoplegia. Eyes Right Unannotated. JETem 2024

The Clue is in the Eyes. A Case Report of Internuclear Ophthalmoplegia

Cooper Nickels, DO*, Christy Keyes, MD*, Caroline Astemborski, MD, MEHP* and Haley Fulton, BS^

DOI: https://doi.org/10.21980/J8DP9M Issue 9:1[mrp_rating_result]
There was no appreciable esotropia or exotropia noted on straight gaze (yellow arrows). On extraocular muscle examination, patient was noted to have a complete left medial rectus palsy consistent with a left internuclear ophthalmoplegia (red arrow). This was evidence by both eyes easily gazing left (green arrows); however, with rightward gaze, her left eye failed to gaze past midline (red arrow).
Visual EMNeurologyOphthalmology

Headache Over Heels: CT Negative Subarachnoid Hemorrhage

Sarah Hogan, MD*, Sara Dimeo, MD, MEHP^ and Caroline Astemborski, MD, MEHP* 

DOI: https://doi.org/10.21980/J8ND2C Issue 8:3[mrp_rating_result]
By the end of this case, the participant will be able to: 1) construct a broad differential diagnosis for a patient presenting with syncope, 2) name the history and physical exam findings consistent with SAH, 3) identify SAH on computer tomography (CT) imaging, 4) identify the need for lumbar puncture (LP) to diagnose SAH when CT head is non-diagnostic > 6 hours after symptom onset, 5) correctly interpret cerebral fluid studies (CSF) to aid in the diagnosis of SAH, and 6) specify blood pressure goals in SAH and suggest appropriate medication management.
NeurologySimulation
Creative Commons images

Epilepsy Caused by Neurocysticercosis: A Case Report

Mary G McGoldrick, MD*, Daniel Polvino, MD* and Grant Wei, MD*

DOI: https://doi.org/10.21980/J81P96 Issue 8:1[mrp_rating_result]
In our patient, two lesions were most notable on CT in the frontal and occipital lobes. The lesion in the left frontal lobe (blue circle) was an approximately 1.5 centimeter (cm) rounded area with rim enhancement and surrounding hypodensity, consistent with vasogenic edema. A similar sized low-density area in the left occipital lobe (red circle) was noted, with increased peripheral density at the 3 o’clock position representing calcification. There were no areas of apparent hemorrhage or midline shift. The final radiology report concluded there were multiple cystic lesions, one with surrounding vasogenic edema in the left frontal lobe.
NeurologyVisual EM