Neurology

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 No ratings yet.

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.

Neurology Simulation

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 No ratings yet.

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.

Neurology Visual EM

A Case Report of a Man with Burning Arm and Leg Weakness

Carolina Ornelas-Dorian, MD^*and Paul Jhun, MD^*

DOI: https://doi.org/10.21980/J8V659 Issue 7:4 No ratings yet.

A non-contrast computed tomography (CT) of the head and neck was performed, followed by an MRI of the cervical spine. The CT demonstrated congenital narrowing of the cervical spinal canal, with posterior disc osteophyte complex and disc bulge at C3-4 and C4-5 (arrow). The T2-weighted MRI additionally demonstrated obliteration of the anterior and posterior subarachnoid space at the level of C3-C5, with associated patchy central cord signal abnormality (arrow).

Neurology Visual EM

Transverse Myelitis in Naloxone Reversible Acute Respiratory Failure—A Case Report

Chance Dodson, MD^*and Joshua Gentges, MD^*

DOI: https://doi.org/10.21980/J8B659 Issue 7:4 No ratings yet.

Magnetic resonance imaging of the brain, cervical, thoracic and lumbar spine without contrast was obtained and revealed increased signal throughout the spinal cord from C-1 to the conus medullaris with mild expansion consistent with transverse myelitis.

Neurology Visual EM

Acute Flaccid Myelitis

Dane Zappa, MD^* and Linda L Herman, MD, FACEP^{^}

DOI: https://doi.org/10.21980/J8MP9G Issue 7:3 No ratings yet.

At the end of this oral board session, examinees will: 1) demonstrate the ability to obtain a complete pediatric medical history; 2) demonstrate an appropriate exam on a pediatric patient including a neurological exam; 3) investigate the broad differential diagnoses for neuromuscular weakness in a pediatric patient; 4) order the appropriate evaluation studies including an MRI; 5) interpret the use of a negative inspiratory force in determining the need for intubation and level of care upon admission; and 6) demonstrate effective communication with parents and caregivers.

Neurology Oral Boards

An Unusual Case Report of a Toddler with Metastatic Neuroblastoma Mimicking Myasthenia Gravis

Raymen Rammy Assaf, MD, MPH^{*^}

DOI: https://doi.org/10.21980/J8G35V Issue 7:1 No ratings yet.

While still in the ED, MRI with and without gadolinium contrast of the brain, orbits, and cervical, thoracic and lumbar spine were obtained to evaluate for possible CNS lesions including encephalitis, myelitis, or demyelination. Imaging, however, demonstrated multiple unexpected findings: a T1 hypointense, T2 hyperintense and heterogeneously enhancing right adrenal mass measuring 2.7 x 2.1 x 3 cm (yellow asterisk) along with heterogenous enhancement at the clivus, C6, C7, T7, T8, T12, and L3 vertebral bodies (red asterisks). There were otherwise no significant intracranial signal or structural abnormalities and normal orbits.

Pediatrics Hematology/Oncology Neurology Visual EM

Case Report of a Man with Right Eye Pain and Double Vision

Nicolas Kahl, MD^* and Maria Pelucio, MD^*

DOI: https://doi.org/10.21980/J8KW7G Issue 7:1 No ratings yet.

ABSTRACT: A 39-year-old previously healthy male presented with three days of right eye pressure and one day of binocular diplopia. He denied history of trauma, headache, or other neurological complaints. He had normal visual acuity, normal intraocular pressure, intact convergence, and no afferent pupillary defect. His neurologic examination was non-focal except for an inability to adduct the right eye past midline

Ophthalmology Neurology Visual EM

Meningococcal Meningitis with Waterhouse-Friderichsen Syndrome

Jonathan Kelley, DO^* and Amrita Vempati, MD^*

DOI: https://doi.org/10.21980/J8TH1K Issue 6:3 No ratings yet.

By the end of this simulation session, learners will be able to: (1) manage a patient with altered mental status (AMS) with fever while maintaining a broad differential diagnosis, (2) recognize the risk factors for meningococcal meningitis, (3) manage a patient with worsening shock and perform appropriate resuscitation, (4) develop a differential diagnosis for thrombocytopenia and elevated international normalized ratio (INR) in an altered febrile hypotensive patient with rash, (5) manage the bleeding complications from WFS, (6) discuss the complications of meningococcal meningitis including WFS, and (7) review when meningitis prophylaxis is given.

Infectious Disease Neurology Simulation

Case Report: Altered with PRES

Fatima Dema, MD^* and David C Feldman, MD^*

DOI: https://doi.org/10.21980/J8NW73 Issue 6:2 No ratings yet.

On vitals, the patient was found to be consistently hypertensive to the 230s/160s. Point-of-care glucose was within normal limits. Noncontrast CT imaging of the head revealed no acute intracranial hemorrhage or evidence of ischemic stroke, but was remarkable for areas of biparietal subcortical low-attenuation (white arrows), concerning for PRES. Patient subsequently underwent CT angiogram imaging of the head with perfusion which revealed no large vessel occlusion.

Neurology Visual EM

A Different Type of Tension Headache: A Case Report of Traumatic Tension Pneumocephalus

Travis P Sharkey-Toppen, MD, PhD^*, Dominique I Dabija, MD, MS^* and Christopher San Miguel, MD^*

DOI: https://doi.org/10.21980/J8DH0G Issue 6:2 No ratings yet.

CT head without contrast demonstrated a minimally displaced fracture of the frontal sinuses at the midline underlying his known laceration that involved the anterior and posterior tables of the calvarium. This is seen on the sagittal view and indicated by the blue arrow. There was a small volume of underlying subarachnoid hemorrhage along the falx. There was also extensive pneumocephalus most pronounced along the bilateral anterior frontal convexity associated with the frontal sinus fracture, seen on the axial image and indicated by the red arrow. This pattern of air is commonly referred to as the “Mount Fuji” sign.6 Other intracranial air can also be seen on the sagittal image and is indicated by the white arrow.

Trauma Neurology Visual EM