A 38-year-old male presents with progressive bilateral upper limb weakness, hand muscle atrophy, and fasciculations for 2 years. Neurological examination reveals mild atrophy in the deltoid, biceps, and forearm muscles, with marked atrophy of the thenar, hypothenar, and interosseous muscles bilaterally. Muscle strength: deltoid IV, elbow flexion/extension V, wrist joint IV, grip IV. Bilateral upper limbs show hypotonia. Biceps and triceps reflexes (±). The most likely diagnosis is:
A 40-year-old male presents with bilateral upper limb weakness, muscle atrophy, and fasciculations for 1 year. No sensory deficit or urinary incontinence. Examination: Shoulder muscle strength V, elbow joint muscle strength V, wrist joint muscle strength IV, opponens pollicis muscle and interosseous muscles strength II-III, slightly increased muscle tone in upper limbs, bilateral biceps and triceps reflexes (+++), right Hoffmann's sign positive, left Babinski sign positive, atrophy of thenar and hypothenar eminences and interosseous muscles bilaterally. The most likely diagnosis is:
A 40-year-old male presents with bilateral upper limb weakness, muscle atrophy, and fasciculations for 1 year. No sensory deficit or urinary incontinence is noted. Examination reveals: shoulder muscle strength grade V, elbow joint muscle strength grade V, wrist joint muscle strength grade IV, opponens pollicis muscle and interosseous muscles strength grade II-III, slightly increased muscle tone in both upper limbs, hyperactive biceps and triceps reflexes (+++), positive Hoffmann's sign on the right, positive Babinski sign on the left, and atrophy of the thenar and hypothenar eminences and interosseous muscles bilaterally. Apart from clinical diagnosis, which test should be prioritized to differentiate this condition from syringomyelia?
A 40-year-old male presents with bilateral upper limb weakness, muscle atrophy, and fasciculations for 1 year. No sensory deficit or urinary incontinence. Examination: shoulder muscle strength grade V, elbow joint muscle strength grade V, wrist joint muscle strength grade IV, opponens pollicis muscle and interosseous muscles strength grade II-III, slightly increased muscle tone in both upper limbs, hyperactive biceps and triceps reflexes (+++), positive Hoffmann's sign on the right, positive Babinski sign on the left, and atrophy of thenar and hypothenar eminences and interosseous muscles bilaterally. If electromyography (EMG) is performed, the findings would most likely show:
A 30-year-old man has been observed by others to have episodes of staring blankly and being unresponsive to questions for 1-2 minutes, accompanied by lip-smacking movements, occurring several times a day for the past 6 months. Neurological examination is normal. EEG shows focal spike activity in the right temporal lobe. The diagnosis is:
Elevated AChR-Ab titer supports the diagnosis of myasthenia gravis (MG). Its specificity and sensitivity are respectively
A 25-year-old woman presents with quadriparesis for 2 weeks, worsening with fatigue and showing diurnal fluctuation (worse in evenings). Neostigmine test is positive. Chest CT reveals thymic hyperplasia. The diagnosis is myasthenia gravis (MG). What is the first-line treatment?
A 30-year-old male presents with ptosis of both eyelids and diplopia for 2 years. Symptoms were temporarily relieved with pyridostigmine. Recently, he developed weakness in neck flexion, difficulty lifting the head, and generalized limb fatigue. Which type of myasthenia gravis (MG) does this patient belong to?
A patient with cerebral cysticercosis shows a space-occupying lesion in the ventricles on cranial MRI, with recurrent episodes of sudden positional severe headache, vomiting, and other symptoms of increased intracranial pressure (ICP). Which treatment should be applied for this patient?
A 66-year-old female patient presented with headache and diplopia. Examination revealed unilateral oculomotor nerve palsy, and cerebral angiography detected an aneurysm. In this scenario, which of the following signs is typically NOT associated with oculomotor nerve damage?
A patient has right-sided limb paralysis. The limb can move against gravity but cannot resist resistance. The muscle strength is graded as:
A 40-year-old male presents with headache and diplopia for 6 months, accompanied by left-sided weakness. Examination reveals right ptosis, right pupil dilation with absent pupillary light reflex, left-sided muscle strength grade 3, increased muscle tone (hypertonia), hyperactive knee reflex, positive Babinski sign, shallow left nasolabial fold, and tongue deviation to the left. The lesion is localized to:
A 55-year-old male underwent partial gastrectomy for gastric cancer 5 years ago. He was admitted with a 2-month history of numbness in both upper limbs. Physical examination revealed: mild anemic appearance, no abnormal cranial nerve signs, normal muscle strength and tone in upper limbs, biceps reflex (++), muscle strength grade IV in lower limbs with slightly increased tone, knee reflexes (+++), left Babinski sign (+), right Babinski sign (-), and decreased pain and vibration sensation in all extremities (distal to wrists and knees). What is the preferred diagnostic test for this patient?
A 30-year-old woman presents with 3 months of left facial pain, characterized by persistent pain with paroxysmal exacerbations. Examination reveals absence of the left corneal reflex, hypoesthesia below the left palpebral fissure, deviation of the mouth to the right when grinning, and left-sided hearing loss. The most likely diagnosis is:
A 38-year-old female patient presents with sudden-onset right-sided limb weakness while washing clothes. Examination reveals: alert and oriented, aphasia, biphasic murmur at the mitral valve area, atrial fibrillation, right hemiplegia (more severe in upper limb), and right-sided hypoesthesia. The most likely diagnosis is:
A 24-year-old previously healthy male woke up with retroauricular pain. One day later, he developed left-sided facial droop and decreased taste sensation on the right side of the tongue. He experienced hyperacusis and right eye discomfort. No diplopia, tinnitus, hearing loss, or limb weakness were present. Examination revealed inability to wrinkle forehead and close eyes on the right side, left-sided mouth deviation when smiling, and herpes zoster in the external auditory canal and auricle. The most accurate diagnosis is:
A 14-year-old male high school student presents with 3 days of progressive weakness in all limbs, worsening over 2 hours with respiratory distress. Examination shows poor respiratory effort, weak voice, normal bowel/bladder function. RR 32/min, intact cranial nerves, limb muscle strength grade 1, absent tendon reflexes, normal sensation, negative pathological signs. Serum K+ 3.8mmol/L, CSF: WBC 5×10<sup>6</sup>/L, protein 0.45g/L, glucose 3.0mmol/L, chloride 122mmol/L. The most likely diagnosis is:
A 42-year-old male presents with 2 days of left facial discomfort and ear canal pain. Examination shows: absent left forehead wrinkles, inability to close left eye, shallow left nasolabial fold, right deviation of the mouth when smiling, decreased taste in anterior 2/3 of left tongue, and small herpes vesicles in left external auditory canal. The lesion is likely localized to:
A 40-year-old male developed right thoracic back pain 2 years ago, right lower limb weakness 1.5 years ago, diminished pain and temperature sensation in the left lower limb, bilateral lower limb weakness over the past 6 months, difficulty climbing stairs, urinary retention and constipation for 3 months, and inability to walk for 1 month. Examination: Normal upper limbs, muscle strength grade 2 in lower limbs, increased muscle tone (hypertonia), hyperactive knee reflex, positive bilateral Babinski signs, decreased pain, temperature, and tuning fork sensation below T7-T8. The most likely diagnosis is:
A 27-year-old male with a history of upper respiratory tract infection (URI) 2 weeks ago. Developed lower limb weakness 3 days ago, followed by upper limb and facial muscle weakness 2 days ago. Examination shows flaccid paralysis in all limbs, absent tendon reflexes, and normal sensation. The most likely diagnosis is:
A 65-year-old male patient, right-handed. Recurrent episodes of left eye blindness for over 1 month, each lasting about 5 minutes. For the past 2 days, difficulty in speech expression accompanied by left-sided headache and right-sided muscle strength weakness. The most likely diagnosis is
A 60-year-old male patient gradually developed right-sided hemiparesis and aphasia over one day. Neurological examination revealed right hemiplegia, right hemisensory loss, right hemianopia, and aphasia. The clinical diagnosis is cerebral thrombosis. The occluded vessel is:
A young male presents with sudden-onset headache for 2 hours, accompanied by nausea and vomiting. Physical examination shows motor aphasia, right-sided hemiplegia, right pupil 3mm, left pupil 4mm with sluggish pupillary light reflex. Which of the following management steps is incorrect?
A 28-year-old male suddenly developed severe headache during physical labor, unbearable, and was urgently sent to the hospital. Physical examination: clear consciousness, normal cranial nerves, normal limb movement, neck stiffness, positive Kernig's sign. The most likely diagnosis is:
A 55-year-old male with a history of hypertension was admitted due to sudden right-sided limb weakness progressing to unconsciousness for 2 hours. Head CT confirmed left basal ganglia hemorrhage. The patient now exhibits unequal pupils (left > right) with sluggish pupillary light reflex on the left. The most urgent treatment required is:
An 80-year-old male with a 10-year history of hypertension presents with sudden increased sleepiness, mouth deviation, and weakness of the right upper and lower limbs. Examination reveals left ptosis, incomplete upward, downward, and adduction movements of the left eye, right central facial and tongue palsy, grade 0 muscle strength in the right upper and lower limbs, bilateral Babinski sign, and right-sided facial and hemibody hypoesthesia. Brain MRI shows long T1 and T2 signals in the left midbrain and bilateral thalamus. The most likely diagnosis is:
A retired male factory worker with a 20-year history of hypertension (irregular medication compliance) suddenly developed headache and lost consciousness during morning exercise. He was brought to the hospital after 30 minutes. Examination shows coma, BP 27/16 kPa, right gaze deviation of both eyes, and external rotation of the left foot. The most likely diagnosis is:
A 69-year-old woman with a 10-year history of hypertension (HTN) on regular antihypertensive medication. Six hours before admission, while watching TV, she suddenly developed numbness and weakness in the right upper and lower limbs, dysarthria, drooling, headache, and vomiting once, followed by somnolence, prompting emergency admission. On arrival, blood pressure (BP) was 26/14 kPa (195/105 mmHg). Which investigation is most diagnostic at this stage?
A 60-year-old female patient was admitted due to sudden onset of impaired movement in the right limb. Past medical history includes diabetes mellitus (DM) and atrial fibrillation. Examination findings: The patient cannot express herself but can understand others; blood pressure (BP) is normal, cardiopulmonary examination is unremarkable, she is conscious and cooperative but unable to speak. Right nasolabial fold is shallow, forehead wrinkles are symmetrical, tongue protrusion deviates to the right, right limb muscle strength is grade 3, and right pathological signs are positive. The patient's speech impairment is classified as:
A 56-year-old male with a history of hypertension for over 10 years was admitted to the emergency department due to sudden-onset headache and hemiplegia after defecation lasting 4 hours, accompanied by vomiting twice. Physical examination: BP 26/14 kPa (195/105 mmHg), left upper and lower limb muscle strength grade 0, hypotonia, and left-sided hemihypesthesia. The most diagnostically and differentially valuable auxiliary examination for this patient is:
A 58-year-old male presents with slurred speech for half a day and right-sided limb movement difficulty for 8 hours. Examination shows motor aphasia, right-sided central facial and tongue palsy, right-sided limb paralysis, and right-sided sensory deficit. Emergency head CT shows no abnormalities. The most likely diagnosis is:
A 66-year-old male presents with bilateral hand tremors and slow movements for 7 years. Physical examination shows mildly impaired memory, 'pill-rolling' resting tremor, 'lead-pipe rigidity', difficulty with buttoning clothes and tying shoelaces, micrographia, and festinating gait. The most likely diagnosis is:
A 16-year-old female developed ptosis 9 days after a cold, without hyperhidrosis or tremors. Examination: normal BP. Pupils round and equal in size, pupillary light reflex present. Moderate impairment of right eye abduction and adduction, mild impairment of upward and downward gaze. Left eye shows only mild adduction impairment. Mild weakness in orbicularis oculi, masseter, and orbicularis oris muscles. Normal limb muscle strength. No muscle atrophy, reflex abnormalities, or sensory deficits. Mild thyroid enlargement. A specific test transiently resolved all neurological symptoms. Which condition is most likely?
A 35-year-old woman presents with ptosis of both eyelids for 6 months. Recently, she developed quadriparesis and dysphagia. No fever or diarrhea. Chest CT shows thymic hyperplasia. On admission, she exhibits cyanosis of the lips and tachypnea. The most likely diagnosis is:
A 28-year-old male wakes up with quadriparesis, predominantly proximal, which progressively worsens. Examination shows proximal muscle strength grade II, distal grade IV, hypotonia, and absent tendon reflexes. Serum K+ is 3.2mmol/L. The most likely diagnosis is:
A 24-year-old male presents with numbness, weakness, and soreness in all four limbs, accompanied by difficulty swallowing and speaking for 15 hours. No urinary dysfunction is noted. Examination reveals flaccid paralysis and absent tendon reflexes in all limbs. Lumbar puncture on the second day shows normal cerebrospinal fluid (CSF) pressure and laboratory tests. Muscle enzymes are normal. Which of the following conditions should be considered?
A 20-year-old male patient developed radiating pain from the right buttock to the posterior thigh and lateral calf after cold exposure, with paroxysmal exacerbation. Physical examination: right Lasegue's sign (+), tenderness at the buttock point, popliteal point, and lateral malleolus (+), reduced pain sensation in the lateral calf and dorsum of the foot, and diminished ankle reflex. The most likely diagnosis is:
A 24-year-old male developed insidious left-sided electric shock-like chest pain 7 months ago, worsening at night. Progressive left lower limb weakness appeared 4 months ago, followed by right lower limb weakness and urinary retention 1 month later. Examination shows normal upper limbs, left lower limb muscle strength 3/5, right 4/5, increased muscle tone (hypertonia), hyperactive tendon reflexes, positive bilateral Babinski signs, and hypoesthesia below the nipples. The most likely diagnosis is:
A 40-year-old male with a history of cold wind exposure to the face 2 days ago presents with drooling from the corner of the mouth upon waking this morning. Physical exam shows: reduced left forehead wrinkles, shallow left nasolabial fold, right deviation of the mouth when smiling, and Bell's phenomenon on left eye closure. Which of the following statements about this patient is INCORRECT?
A 24-year-old male, previously healthy, woke up with retroauricular pain. After 1 day, he developed left-sided facial droop and decreased taste sensation on the right side of the tongue. He also experienced hyperacusis and right eye discomfort. No diplopia, tinnitus, hearing loss, or limb weakness were noted. Examination: Right-sided inability to frown, raise eyebrows, or close the eye; left-sided facial droop on grinning; decreased taste sensation on the anterior right tongue. The most likely site of lesion is:
A young male presents with thoracic back pain for 2 days, followed by lower limb weakness this morning, accompanied by bowel/bladder dysfunction. Examination reveals sensory deficit below the umbilicus and 0/5 muscle strength in both lower limbs, without pathological reflexes. The most likely diagnosis is:
A 54-year-old male with cervical X-ray showing osteophyte formation 2-3 years ago. Over the past month, he developed bilateral lower extremity numbness progressing from the feet up to the inguinal region. In the past week, bilateral upper extremity numbness and weakness appeared, with no urinary/bowel dysfunction. Acupuncture treatment provided no relief. What should be emphasized in history-taking?
A 23-year-old male has experienced 5 episodes of generalized tonic-clonic seizures within 4 hours. He has a 15-year history of epilepsy and has been on long-term phenytoin therapy. On admission: light coma, temperature 38°C, normal blood pressure. Two more episodes occurred after admission. Which of the following initial management steps is inappropriate?
A 72-year-old male with a 20-year history of hypertension (HTN) developed leftward deviation of the mouth, inability to puff the right cheek, and flattening of the right nasolabial fold 2 days ago. Both eye closure and forehead wrinkling are normal. The lesion is located in:
A 70-year-old female patient with no history of hypertension (HTN) or diabetes mellitus (DM) presents with headache and left-sided weakness lasting 2 hours during activity. She has a history of two prior strokes. Brain computed tomography (CT) reveals a hyperdense lesion near the cortex of the right parietal lobe. The most likely diagnosis is:
A 56-year-old female presents to the emergency department with double vision, facial deviation, and weakness in both lower limbs for 8 hours. Examination: Alert, normal temperature, normal blood pressure (BP), equal pupils, restricted horizontal eye movements, bilateral facial palsy, inability to protrude tongue. Muscle strength grade 2 in upper limbs, grade 0-1 in lower limbs. No significant sensory deficit. No nuchal rigidity. Brain computed tomography (CT) from another hospital showed no abnormalities. Based on the clinical presentation, the most likely diagnosis is:
A 40-year-old woman suddenly developed severe headache, occipital pain, and vomiting for 8 hours, without fever. No history of hypertension. Physical examination: clear consciousness, mild hypertension. Right pupil dilated with absent pupillary light reflex, right upper eyelid ptosis, and inability to move the eye upward, downward, and inward. Nuchal rigidity, Kernig's sign (+). Brain CT shows hyperdense signals in the interhemispheric fissure, lateral sulcus, and basal cistern. The most likely diagnosis is:
A 60-year-old woman noticed numbness in her right upper and lower limbs upon waking in the morning but could use the toilet independently. She fell when returning to the bedroom due to right lower limb weakness. Examination: clear consciousness, mild right hemiplegia, and hemisensory loss. The most likely diagnosis is:
A 65-year-old female presents with left-sided hemiplegia for 1.5 hours. Past medical history includes hypertension for 10 years. Examination findings: alert and oriented, pupils equal and round, muscle strength grade 2. Which diagnostic test is most valuable for confirming the diagnosis?
A 70-year-old male patient presents with sudden headache, nausea, and vomiting for 3 hours. Physical examination: BP 190/115 mmHg, right-sided deviation of the mouth, shallow left nasolabial fold, left-sided tongue deviation, and left hemiplegia. The lesion is most likely localized to:
A retired male factory worker with a 20-year history of hypertension (irregular medication compliance) suddenly developed a headache and lost consciousness during morning exercise. He was brought to the hospital 30 minutes later. Examination reveals coma, BP 27/16 kPa, right gaze deviation of both eyes, and external rotation of the left foot. The most likely site of the lesion is:
A 69-year-old woman with a 10-year history of hypertension (HTN) on regular antihypertensive medication. Six hours before admission, while watching TV, she suddenly experienced numbness and fatigue in the right upper and lower limbs, dysarthria, drooling, headache, and vomiting once, followed by somnolence, prompting emergency admission. On arrival, BP was 195/105 mmHg (26/14 kPa). After confirming the diagnosis, the most appropriate management at this stage is:
A 60-year-old female patient was admitted due to sudden onset of impaired movement in the right limb. Past medical history includes diabetes mellitus (DM) and atrial fibrillation. Examination: The patient cannot express herself but can understand others; normal blood pressure (BP), no abnormalities on cardiopulmonary exam, conscious, cooperative, but unable to speak. Right nasolabial fold is shallow, forehead wrinkles are symmetrical, tongue deviates to the right, right limb muscle strength is grade 3, and right pathological signs are positive. The most likely diagnosis is:
A 56-year-old male with a history of hypertension for over 10 years presents to the emergency room with sudden-onset headache and hemiplegia after defecation lasting 4 hours, accompanied by vomiting twice. Physical examination: BP 26/14 kPa (195/105 mmHg), left upper and lower limb muscle strength grade 0/5, hypotonia, and left-sided hemihypesthesia. Which of the following is the most likely diagnosis?
A 60-year-old female with long-standing dizziness sought no medical attention. Sudden onset of unconsciousness for 2 hours led to a diagnosis of intracerebral hemorrhage. The most common artery involved in intracerebral hemorrhage is:
A 58-year-old male presents with slurred speech for half a day and right-sided limb movement difficulty for 8 hours. Examination shows motor aphasia, right-sided central facial and tongue palsy, right-sided hemiplegia, and right-sided sensory deficit. Emergency head CT shows no abnormalities. The most likely location of the brain lesion in this case is:
A 23-year-old male experienced 5 episodes of generalized tonic-clonic seizures within 4 hours. He has a 15-year history of epilepsy and has been on long-term phenytoin therapy. On admission: light coma, temperature 38°C, normal blood pressure (BP). Two additional seizures occurred after admission. Which of the following management steps is LEAST appropriate?
A 15-year-old male suddenly screamed, fell to the ground, exhibited upward eye deviation, convulsions of the limbs, and cyanosis lasting about 5 minutes before gradually regaining consciousness without discomfort. A similar episode occurred 5 years ago. EEG one week ago was normal. Neurological examination showed no abnormalities. During follow-up one week later, he reported two more episodes yesterday afternoon and this morning with identical symptoms. The first-line treatment drug is:
A 66-year-old male presents with 7 years of bilateral hand tremors and slowed movements. On examination: mild memory impairment, 'pill-rolling' resting tremor, 'lead-pipe' rigidity, difficulty with buttoning clothes and tying shoelaces, micrographia, and festinating gait. Which of the following is most valuable for diagnosing this condition?
A 52-year-old woman developed right upper and lower limb pain with mild tremor (more pronounced at rest) 2 years ago after IV fluids for high fever lasting 7-8 days. Over the past 3 months, left limb tremor appeared, worsened by emotional stress but disappearing during sleep, accompanied by limb stiffness and small-step gait. Examination: masked facies, drooling from the corner of the mouth, generalized tremor, lead-pipe muscle rigidity, head forward tilt, and bradykinesia. Brain MRI was normal. Which of the following drugs should NOT be used in pharmacotherapy?
A 16-year-old female developed ptosis 9 days after a cold, without hyperhidrosis or tremor. Examination: Normal BP. Pupils round and equal in size, pupillary light reflex present. Moderate impairment of right eye abduction and adduction, mild impairment of upward and downward gaze. Left eye shows only mild adduction impairment. Mild muscle strength reduction in orbicularis oculi, masseter, and orbicularis oris muscles. Normal limb muscle strength. No muscle atrophy, reflex abnormalities, or sensory deficits. Mild thyroid enlargement. A transient complete resolution of neurological symptoms was observed after a specific test. Which ancillary test is most closely related to confirming this diagnosis?
A 35-year-old woman presents with ptosis of both eyelids for 6 months. Recently, she developed quadriparesis and dysphagia. No fever or diarrhea. Chest CT reveals thymic hyperplasia. On admission, she exhibits cyanosis of the lips and tachypnea. The simplest diagnostic method for this patient is:
A 28-year-old male wakes up with quadriparesis, predominantly proximal, progressively worsening. Examination: proximal muscle strength grade II, distal grade IV, hypotonia, absent tendon reflexes. Serum K+ 3.2mmol/L. The most diagnostic intervention is:
A 52-year-old male presents with 2 years of bilateral lower limb stiffness and fatigue, and 6 months of bilateral upper limb fatigue with muscle atrophy. Physical exam: atrophy of thenar and hypothenar eminences, visible muscle fasciculations, spastic hypertonia in all limbs, limb muscle strength grade 4, positive patellar and ankle clonus, bilateral positive Babinski sign. The most likely diagnosis is:
A 40-year-old male presented with drooling from the corner of the mouth after waking up this morning. He had a history of cold wind exposure to the face 2 days prior. Examination revealed: reduced left forehead wrinkles, shallow left nasolabial fold, right deviation of the mouth when smiling, and Bell's phenomenon on closure of the left eye. The most likely diagnosis is:
A 24-year-old male, previously healthy, woke up with retroauricular pain one morning. After 1 day, he developed left-sided facial droop and decreased taste sensation on the right side of the tongue. He experienced hyperacusis and right eye discomfort. No diplopia, tinnitus, hearing loss, or limb weakness were present. Physical exam: inability to frown, raise eyebrows, or fully close the right eye; left-sided facial droop when smiling; decreased taste sensation on the anterior right tongue. The most accurate diagnosis is:
A 59-year-old woman presents to the outpatient clinic with episodes of severe facial pain. The pain starts from the right corner of the mouth, spreads to the right cheek, and is described as knife-like or tearing in nature, with paroxysmal episodes lasting a few seconds each. It is often triggered by talking, brushing teeth, or chewing. The most likely diagnosis is:
A 25-year-old woman developed fever after a cold 2 weeks post-cesarean delivery. 20 days later, she experienced mid-thoracic numbness with a band-like sensation, complete sensory loss below the band, lower limb weakness, and urinary incontinence. On examination: absent tendon reflexes in both lower limbs, negative pathological signs, and flaccid paralysis. Which condition should be considered?
A 22-year-old female presents to the emergency department with bilateral shoulder pain, limb weakness, numbness, and difficulty urinating for 1 day, preceded by an upper respiratory infection. Examination shows: cranial nerves (-), limb tendon reflexes (++), muscle strength grade 3, sensory deficit below the shoulders and clavicles, and bilateral Babinski sign (-). Spinal X-ray and CT are normal. Lumbar puncture reveals colorless, clear cerebrospinal fluid (CSF) with WBC 0×10<sup>6</sup>/L (10/mm<sup>3</sup>), RBC 0×10<sup>6</sup>/L, protein 500mg/L (50mg/dl), and Queckenstedt test (-). The most likely diagnosis is:
A 65-year-old male presents with sudden-onset coma. He has a 20-year history of diabetes mellitus (DM) and hypertension (HTN), and a 5-year history of coronary artery disease (CAD). Left-sided Babinski sign is positive. The most important diagnostic test is:
A 40-year-old woman suddenly developed severe headache, occipital pain, and vomiting for 8 hours, without fever. No history of hypertension (HTN). Physical exam: alert, mild hypertension (BP). Right pupil dilated, absent pupillary light reflex, right upper eyelid ptosis, inability to move the eye upward, downward, and inward. Nuchal rigidity, Kernig's sign (+). Brain CT shows hyperdense signals in the interhemispheric fissure, lateral sulcus, and basal cistern. The affected cranial nerve is:
A 70-year-old male patient presents with sudden headache, nausea and vomiting for 3 hours. Physical examination: BP 190/115 mmHg, right deviation of the mouth angle, shallow left nasolabial fold, left deviation of the tongue, and left hemiplegia. If the condition progresses, which of the following pupillary changes is most likely to occur first?
A retired male factory worker with a 20-year history of hypertension (HTN) and irregular medication adherence suddenly developed a headache during morning exercise, followed by loss of consciousness. He was brought to the hospital 30 minutes later. Physical examination reveals coma, blood pressure (BP) 27/16 kPa, right gaze deviation of both eyes, and external rotation of the left foot. Which diagnostic test is most valuable for further evaluation?
A 69-year-old woman with a 10-year history of hypertension (HTN) and regular use of antihypertensive medication. Six hours before admission, while watching TV, she suddenly experienced numbness and weakness in the right upper and lower limbs, dysarthria, drooling, headache, and vomiting once, followed by somnolence, prompting emergency admission. On admission, BP was 195/105 mmHg (26/14 kPa). Three months later, her condition stabilized, with near-complete recovery of right-sided hemiplegia and regained independence in daily activities, but BP remained elevated. What is the best management at this stage?
A 56-year-old male with a history of hypertension for over 10 years was admitted to the emergency department due to sudden headache and hemiplegia after defecation, lasting 4 hours, accompanied by vomiting twice. Physical examination: BP 26/14 kPa (195/105 mmHg), left upper and lower limb muscle strength grade 0/5, hypotonia, and left-sided hemihypesthesia. Which of the following treatment principles is NOT applicable for this patient?
A 60-year-old woman with long-standing dizziness presented with sudden onset of unconsciousness for 2 hours and was diagnosed with intracerebral hemorrhage. On day 3 of hospitalization, examination revealed: deep coma, left pupil diameter 3.5 mm, right pupil diameter 2.0 mm, absent pupillary light reflex, bilateral positive Babinski sign, and respiratory rate of 14 breaths per minute with regular and stable rhythm. The patient likely developed
A 58-year-old male presents with slurred speech for half a day and right-sided limb movement difficulty for 8 hours. Examination shows motor aphasia, right-sided central facial and tongue palsy, right-sided limb paralysis, and right-sided sensory deficit. Emergency head CT shows no abnormalities. [Hypothetical scenario] If the condition progressively worsens with impaired consciousness, left pupil dilation, and sluggish pupillary light reflex, the most urgent intervention required is:
A 35-year-old woman presents with ptosis of both eyelids for 6 months. Recently, she developed quadriparesis and dysphagia. No fever or diarrhea. Chest CT reveals thymic hyperplasia. On the day of admission, she exhibits cyanosis of the lips and tachypnea. The most likely cause of the cyanosis and tachypnea is:
A 28-year-old male wakes up with quadriparesis, predominantly proximal, progressively worsening. Examination: proximal muscle strength grade II, distal grade IV, hypotonia, absent tendon reflexes. Emergency serum K<sup>+</sup> 3.2mmol/L. The most likely associated condition is:
A 20-year-old male patient presents with muscle strength grade 3 in all four limbs for 4 days, no bowel and bladder dysfunction, and no fever. Examination shows limb muscle strength grade 3, hypoesthesia in distal limbs, absent tendon reflexes, and no pathological reflexes. CSF is normal. During disease progression, the patient develops respiratory muscle paralysis. The most critical intervention at this stage is:
A 24-year-old male, previously healthy, woke up with retroauricular pain. After 1 day, he developed left-sided facial droop and decreased taste sensation on the right side of the tongue. He experienced hyperacusis and right eye discomfort. No diplopia, tinnitus, hearing loss, or limb weakness were noted. Examination: inability to frown, raise eyebrows, or close the right eye; left-sided facial droop on grinning; decreased taste sensation on the anterior right tongue. All of the following should be considered for differential diagnosis EXCEPT:
A 59-year-old woman presents to the outpatient clinic with episodes of severe facial pain. The pain starts at the right corner of the mouth, spreads to the right cheek, and is described as knife-like or tearing in nature, with paroxysmal attacks lasting a few seconds each. It is often triggered by talking, brushing teeth, or chewing. This type of pain can occasionally be seen in the following conditions, EXCEPT:
A 16-year-old male presents with muscle strength grade 3 in all four limbs and numbness for 10 days. He had diarrhea 10 days prior, which resolved in 2 days. Examination shows clear consciousness, bilateral peripheral facial palsy, muscle strength grade 2 in limbs, hypotonia, absent tendon reflexes, calf tenderness, and sock-glove pattern sensory loss. CSF analysis: WBC 4×10<sup>6</sup>/L, protein 0.6g/L, glucose 3.2mmol/L, chloride 122mmol/L. If this represents acute motor axonal neuropathy (AMAN) variant of Guillain-Barré syndrome, the most common infectious pathogen is:
A 22-year-old woman presents to the emergency department with bilateral shoulder pain, limb weakness, numbness, and difficulty urinating for 1 day, following a recent upper respiratory infection. Examination shows: cranial nerves intact, limb tendon reflexes (++), muscle strength grade 3, sensory deficit below the shoulders, and bilateral negative Babinski sign. On day 2, her condition worsens with muscle strength grade 0 in all limbs, absent tendon reflexes, decreased muscle tone, bilateral negative Babinski sign, and urinary retention. This presentation is now consistent with:
A 40-year-old woman suddenly developed severe headache, occipital pain, and vomiting for 8 hours, without fever. No history of hypertension. Physical exam: conscious, mild hypertension. Right pupil dilated with absent pupillary light reflex, right upper eyelid ptosis, inability to move the eye upward, downward, and inward. Nuchal rigidity, Kernig's sign (+). Brain CT shows hyperdense signals in the interhemispheric fissure, sylvian fissure, and basal cisterns. If cerebrospinal fluid (CSF) examination is performed, which of the following is most likely to be found?
A 70-year-old male patient presents with sudden headache, nausea, and vomiting for 3 hours. Physical examination: BP 190/115 mmHg, right-sided mouth deviation, shallow left nasolabial fold, left tongue deviation, and left hemiplegia. Which of the following management steps is currently inappropriate for this case?
A 56-year-old male with a history of hypertension for over 10 years was admitted to the emergency department due to sudden headache and hemiplegia after defecation, lasting 4 hours, accompanied by vomiting twice. Physical examination: BP 26/14 kPa (195/105 mmHg), left upper and lower limb muscle strength grade 0/5, hypotonia, and left-sided hemihypesthesia. [Hypothetical scenario] If the patient suddenly becomes unconscious 10 hours after admission, with BP 26/14 kPa, comatose state, no response to orbital compression, pupil diameter: right 3.5 mm, left 2.5 mm, absent pupillary light reflex, and bilateral Babinski sign (+), the most likely diagnosis and prognosis are:
A 17-year-old male presents with a 2-month history of episodic limb convulsions. During episodes, he loses consciousness for about 5 minutes, occasionally with urinary incontinence. Neurological examination during interictal periods shows no abnormalities. After 1 year of pharmacotherapy, seizure frequency has significantly reduced to 3-4 episodes per year. The most appropriate next step is:
A 67-year-old female patient has experienced right hand tremors and slow walking for 4 years. After neurological examination, Parkinson's disease was suspected. Symptoms initially improved with medication but later worsened. Additional drugs including trihexyphenidyl, amantadine, bromocriptine, and diphenhydramine were introduced. Recently, symptoms suddenly fluctuated between exacerbation and relief, accompanied by dyskinesia. Which drug's side effect is this phenomenon?
A 35-year-old woman presents with ptosis of both eyelids for 6 months. Recently, she developed quadriparesis and dysphagia. No fever or diarrhea. Chest CT revealed thymic hyperplasia. On admission, she developed cyanosis of the lips and tachypnea. She had been taking pyridostigmine 60mg four times daily for the past 3 months. On admission, after intramuscular neostigmine 1mg, her symptoms worsened after 1 hour. The most appropriate emergency management is:
A 21-year-old female presents with 3 months of limb weakness that worsens in the evening and significantly deteriorated this afternoon, along with slurred speech and dysphagia. She denies limb pain and has normal bowel/bladder function, with a history of hyperthyroidism. After 2 months of treatment with stable respiration and restored muscle strength, a thymoma is detected. The next step should be:
A 70-year-old male patient suddenly developed headache, nausea and vomiting for 3 hours. Physical examination: BP 190/115 mmHg, right-sided mouth deviation, shallow left nasolabial fold, left-sided tongue deviation, and left hemiplegia. The patient soon developed unilateral fixed pupil dilation followed by death. Based on the neurological symptoms and signs, the patient most likely developed
A 70-year-old male patient suddenly developed headache, nausea and vomiting for 3 hours. Physical examination: BP 190/115 mmHg, right deviation of the mouth angle, shallow left nasolabial fold, left deviation of the protruded tongue, left hemiplegia. Soon after, one pupil became dilated and fixed. Based on the neurological symptoms and signs, the patient most likely developed
A 56-year-old male with a history of hypertension for over 10 years was admitted to the emergency department due to sudden headache and hemiplegia after defecation, lasting 4 hours, accompanied by vomiting twice. Physical examination: BP 26/14 kPa (195/105 mmHg), left upper and lower limb muscle strength grade 0/5, hypotonia, and left-sided hemihypesthesia. Based on the clinical scenario, which of the following management options is incorrect?
A 25-year-old female developed fever after a cold 2 weeks post-cesarean delivery. 20 days later, she experienced mid-chest numbness with a band-like sensation, complete sensory loss below the band, lower limb weakness, and urinary incontinence. If the patient also presents with bilateral peripheral facial palsy, decreased limb muscle strength, absent tendon reflexes, and cerebrospinal fluid (CSF) showing albuminocytologic dissociation, which disease should be considered?
A 16-year-old male presents with muscle strength grade 3 in all four limbs and numbness for 10 days. He had diarrhea 10 days prior, which resolved in 2 days. Examination: clear consciousness, bilateral peripheral facial palsy. Limb muscle strength grade 2, decreased muscle tone, absent tendon reflexes, calf tenderness, and stocking-glove pattern sensory disturbance. CSF findings: WBC count 4×10<sup>6</sup>/L, protein 0.6g/L, glucose 3.2mmol/L, chloride 122mmol/L. On day 3 of hospitalization, the patient develops shortness of breath, dyspnea, weak cough, and cyanosis of the lips. Arterial oxygen tension is 60mmHg despite oxygen therapy (5L/min). The immediate action required is:
The main clinical features of cerebral thrombosis are:
What is the optimal treatment or preventive therapy for the following condition? A 70-year-old female patient has experienced episodic burning pain in the right cheek for 3 years, with each episode lasting tens of seconds and normal intervals between attacks.
A 22-year-old woman has experienced recurrent episodes of flashing lights in her vision for many years, lasting a few minutes before disappearing, followed by bilateral throbbing headache in the frontotemporal region accompanied by nausea and vomiting, lasting several hours before relief. Neurological examination is completely normal.
A 7-year-old girl has had recurrent headaches for 4 years. Before the headache, she experiences numbness and weakness in her right limbs, which improves after about 30 minutes. This is followed by throbbing headache in the right temporal and retro-orbital region, accompanied by photophobia, phonophobia, and sometimes nausea and vomiting. Symptoms typically resolve within a day, and the hemiplegia/numbness disappears tens of minutes after the headache ends. Episodes occur once every 1-2 months, with complete normality between attacks.
Differentiation between primary trigeminal neuralgia and secondary trigeminal neuralgia
A 28-year-old male, previously healthy, had a cold 2 weeks ago. He developed lower limb weakness 3 days ago and bilateral upper limb weakness 2 days ago, unable to maintain a sitting position or lie down independently. Examination: bilateral peripheral facial palsy, flaccid paralysis of all limbs, absent tendon reflexes, and mild glove-and-stocking sensory deficit in the distal limbs. The correct diagnosis is:
For the following condition, the best treatment or preventive therapy is: A 20-year-old male patient suddenly developed left eye tearing and deviation of the mouth angle two days after exposure to wind and cold. Examination reveals loss of left forehead wrinkles, inability to close the left eye, shallow left nasolabial fold, mouth angle deviated to the right, and normal limb movements.
The preferred treatment for this patient is: A 48-year-old male with 2 years of progressive weakness in both lower limbs and 3 months of difficulty urinating and constipation. Examination: muscle strength III in both lower limbs, hyperactive knee and ankle reflexes, positive bilateral Babinski signs, positive bilateral Chaddock signs, hypoesthesia below the T8 level. Lumbar puncture: elevated cerebrospinal fluid protein. Queckenstedt test showing complete spinal canal obstruction. MRI showing an intraspinal mass-like soft-tissue lesion with spinal cord compression.
A 30-year-old male presents with recurrent episodes of right-sided throbbing headache lasting 1-2 days each, accompanied by nausea and vomiting. Neurological examination is normal, and brain MRI shows no abnormalities.
A 35-year-old previously healthy male developed low-grade fever (37.5°C) and malaise for 1 day a week ago, followed by numbness and weakness in both feet that progressively worsened. Within 3 days, he developed complete paraplegia and fecal incontinence. Examination reveals complete paralysis of both lower limbs, hypotonia, bilateral negative Babinski sign, loss of pain/touch sensation and anhidrosis below the nipple level. Lumbar puncture shows normal cerebrospinal fluid (CSF), patent spinal canal, and unremarkable spinal X-rays. The correct diagnosis is:
Perianal and perineal sensory loss, bowel and bladder dysfunction, without lower limb paralysis
What is the optimal treatment or preventive therapy for the following condition: A 25-year-old female patient has experienced recurrent episodes of right-sided throbbing frontotemporal headache accompanied by vomiting over the past 5 years. Each episode lasts several hours and resolves spontaneously, occurring 2-3 times per month.
What is the first-line treatment for this patient? A 23-year-old male has experienced multiple episodes over 3 years where he wakes up in the morning after a heavy evening meal unable to move his limbs, with normal bowel/bladder function, swallowing, and breathing. Episodes last several days and have recurred 5 times. This morning, he again developed limb paralysis. Examination shows normal cranial nerves, limb muscle strength of grade I, hypoactive reflexes, no pathological reflexes, and normal sensation.
An 18-year-old female presents with visual acuity decline for 2 years and recurrent episodes of limb paralysis for 1 year, partially relieved after two hospitalizations. Findings include positive oligoclonal bands in cerebrospinal fluid (CSF) and abnormal visual and somatosensory evoked potentials. MRI shows multiple T2-weighted hyperintense lesions in cerebral white matter. The most likely diagnosis is:
An 18-year-old female presents with visual acuity decline for 2 years and recurrent episodes of limb paralysis for 1 year, with partial relief after two hospitalizations. Positive oligoclonal bands in cerebrospinal fluid (CSF) and abnormal visual and somatosensory evoked potentials were noted. MRI shows multiple T<sub>2</sub>-weighted hyperintense lesions in white matter. The preliminary diagnostic basis for this patient is:
A 2-year-old male presented with progressive head enlargement noticed since 6 months of age. Examination: alert, only able to say 'dad' and 'mom', unsteady standing, enlarged head with dilated scalp veins, upward gaze palsy. Head CT shows marked enlargement of bilateral lateral and third ventricles with midline structures in place, normal fourth ventricle size/shape. MRI reveals aqueductal stenosis. Which factor does NOT cause communicating hydrocephalus?