A biopsy of the spinal cord is performed, and widespread granulomas are found at the level of the patchy irregularity seen on MRI. In the midst of one granuloma is an ovoid mass with a spine extending from one side. The pathologist interprets this as a parasitic ovum. If the pathologist is correct, the most likely cause of the lesion is
Because of the obvious aortic aneurysm discovered on aortography, the vascular surgeon consulting on the case recommends a bypass procedure. Preoperatively the patient showed substantial recovery of leg strength and sensation, despite the persistence of bilateral Babinski (plantar extensor) signs. The patient submits to the surgery and is paraplegic postoperatively with dense loss of sensation of pain and temperature below the level of T10. A follow-up aortogram should reveal
Because the facial weakness persists despite antituberculous treatment, the physician decides to administer high-dose steroids. Within 1 week of the introduction of prednisone, the patient develops pain radiating down the back of his right leg and difficulty dorsiflexing the right foot. This new complaint probably represents which of the following disorders?
A 25-year-old woman is being examined by her physician. The knee jerk is being tested. The patellar tendon reflex involves sensory fibers of the femoral nerve that originate in spinal segments
A 51-year-old factory worker has noticed progressive weakness over the past year. Examination and testing reveal a painless largely motor peripheral neuropathy. Of the following agents, the one most likely to be etiologic in this case is
A very thin elderly woman complains of left-sided neck pain. Her family attempted to give her a deep intramuscular injection of steroids. She complains acutely of pain radiating down her arm and develops a wristdrop. The probable site of injection is the
A 27-year-old man undergoes general anesthesia for a hernia repair-As the anesthesia begins, his jaw muscles tense and he becomes generally rigid. He becomes febrile, tachycardic, and tachypneic. Intravenous administration of which agent may be lifesaving?
A 66-year-old woman presents with fever and a generalized convulsion. Neuroimaging and lumbar puncture are most consistent with a diagnosis of herpes encephalitis. The most appropriate treatment for this patient is which of the following?
Febrile seizures cause increased intracranial pressure that must be relieved by withdrawing cerebrospinal fluid (CSF)
Intrathecal antiepileptics must be given
*Children this age may have meningitis with no manifestations other than fever and seizures
A 17-year-old girl presents with subacute mental status change and left arm weakness. She had a viral illness 1 week ago and now a diagnosis of acute disseminated encephalomyelitis (ADEM) is made. ADEM is a white matter disease that is distinguishable from multiple sclerosis (MS) by its being
Associated with magnetic resonance imaging (MRI) lesions, which may resolve
Associated with inflammatory changes in the brain
A 57-year-old man has been diagnosed with cluster headache. Ergotamine prophylaxis has been partially successful. The most effective means of aborting a cluster headache is
*Inhaled 100% oxygen
A 33-year-old operating room nurse accidentally has blood splashed in her eyes during a procedure. The surgical resident who examines her immediately afterward notices that she has 2-mm anisocoria and sends her to the emergency room. She feels well, is alert and talkative, and has no motor dysfunction. On examination, the emergency room physician recognizes that the iris of the eye with the smaller pupil is pale blue, while that of the other eye is brown. The etiology of the woman's anisocoria is probably