A 21-year-old man has noted that he has some difficulty seei…

A 21-year-old man has noted that he has some difficulty seeing and occasionally will see not only blurry objects but more than one image. He notes that this has been going on for 2 months and occasionally his eyelid will also droop. He says this is worse at night after working on term papers late at night. You are consulted about the patient’s diplopia. On examination, the patient has some inconsistent weakness on right eye abduction. The rest of the neurologic examination is normal. What is the most likely diagnosis?

A 56-year-old woman is brought to the ED after collapsing at…

A 56-year-old woman is brought to the ED after collapsing at home.  She is diagnosed with hemorrhage following rupture of a cerebral aneurysm in the anterior circulation.  The hemorrhage is confirmed on CT of the head, and the decision is made for the patient to undergo endovascular coiling rather than surgical clipping. Approximately one week after the initial bleed, she experiences an acute decline in mental status, and magnetic resonance imaging confirms a new infarct in the left posterior cerebral artery territory.  Based on the history and time course, what medication could have prevented this complication?

A 39-year-old obese African-American man presents with sever…

A 39-year-old obese African-American man presents with several episodes of weakness and tingling in his right forearm. This morning he became extremely concerned when he was unable to grip his coffee cup and could not open the car door.  He is an electrician and has been unable to go to work for the past week because of these episodes.  He notes that he has also been awakened at night with numbness and tingling in the same arm. He has a history of diabetes and has smoked for 25 years. He reports that his father also has diabetes and recently had coronary artery bypass surgery. Physical examination reveals weak grip of the right hand compared to the left with signs of thenar atrophy. Which of the following nerves is most likely affected?

A 27-year-old African American woman comes to the clinic bec…

A 27-year-old African American woman comes to the clinic because of progressive weakness and difficulty walking for a few days. She also notes that her fingers have been feeling “numb and tingly” in the last 2 days. She tells you that she is generally very healthy except for an upper GI infection 2-3 weeks ago that lasted for 4 days. There is no history of trauma. Her temperature is 37.0 C (98.6 F) blood pressure is 125/80 mm Hg, pulse is 70/min, and respirations are 12/min. On physical examination, her extraocular movements are full. There is weakness in her hands and throughout her lower extremities with decreased tone. What additional finding on your examination would most strongly support your suspected diagnosis?