AKT – Neurological presentations

Daniela Russo, aged 34, presents with a two-week history of right-sided facial weakness. She reports inability to close her right eye and drooping of the right side of her mouth. There is no limb weakness or sensory loss. She recently had a cold sore outbreak. Examination reveals weakness of the forehead muscles on the affected side.

What is the MOST likely diagnosis?

Gregory Tan, aged 67, presents with an episode of transient right arm weakness and expressive aphasia that resolved within 20 minutes. He has a history of hypertension and smokes 20 cigarettes a day. Examination is currently normal.

What is the MOST appropriate next step in management?

Emily Weston, aged 22, presents with new onset generalised tonic-clonic seizure witnessed by her partner. She was post-ictal for 15 minutes. She has no past history of seizures or head trauma. Examination is normal, and she is alert and oriented.

What is the MOST appropriate initial investigation?

Natalie Ford, aged 56, presents with worsening headaches over the last two months, worse in the mornings and associated with nausea. She has also developed blurred vision and difficulty with balance. On examination, there is papilloedema bilaterally.

What is the MOST likely diagnosis?

Owen Kennedy, aged 70, presents with a resting tremor in his right hand that has gradually progressed over the past year. He also reports stiffness and bradykinesia. Examination confirms a 4 Hz resting tremor, cogwheel rigidity and shuffling gait.

What is the MOST likely diagnosis?

Angela Moorcroft, aged 45, presents with sudden onset severe occipital headache described as ‘the worst headache of her life’. She felt nauseated and vomited shortly after the onset. She has no significant past medical history. Examination reveals photophobia but no focal neurological signs.

What is the MOST appropriate immediate investigation?

Thomas Rawlings, aged 29, presents with right-sided facial pain described as sharp, electric shocks triggered by chewing and touching his cheek. The episodes last seconds but recur throughout the day. Neurological examination is normal.

What is the MOST likely diagnosis?

Elise Zhang, aged 62, presents with progressive memory impairment and difficulty performing daily tasks over the past year. Her daughter reports that she often repeats herself and gets lost in familiar places. Mini-Mental State Examination (MMSE) score is 22/30.

What is the MOST likely diagnosis?

Jared Miller, aged 64, presents with unsteady gait and falls. He also has urinary incontinence and memory problems. Examination reveals a broad-based gait. CT brain shows enlarged ventricles without cortical atrophy.

What is the MOST likely diagnosis?

Lisa Caruso, aged 28, presents with acute onset of blurred vision in her left eye and pain on eye movement. She reports colours appearing faded. There are no other symptoms. Examination reveals a left relative afferent pupillary defect (RAPD) and reduced visual acuity. Fundoscopy is normal.

What is the MOST likely diagnosis?

Matthew Li, aged 58, presents with left-sided weakness and slurred speech that started two hours ago. He has a history of atrial fibrillation and is not on anticoagulation. His CT brain is normal, and his NIHSS score is 6.

What is the MOST appropriate next step in management?

Tahlia Roberts, aged 36, presents with bilateral leg weakness, numbness, and unsteady gait that developed over 48 hours. She had a diarrhoeal illness a week ago. Examination reveals absent ankle reflexes and symmetrical weakness of the lower limbs. Plantar responses are flexor.

What is the MOST likely diagnosis?

Sophie Brennan, aged 49, presents with a 3-month history of right-sided headaches associated with tearing of the eye and nasal congestion. Attacks last about 90 minutes and occur almost daily. Examination between episodes is normal.

What is the MOST likely diagnosis?

Jason Tran, aged 41, presents with numbness and tingling in the lateral three fingers of his right hand, worse at night and when using the computer. Tinel’s and Phalen’s signs are positive.

What is the MOST likely diagnosis?

Renee Collins, aged 75, presents with sudden visual loss in her right eye. She describes it as a curtain coming down over her vision. She also reports scalp tenderness and jaw pain when chewing. ESR is 88 mm/hr.

What is the MOST likely diagnosis?

Michael Chan, aged 23, presents after experiencing a sudden loss of consciousness while standing in church. Witnesses describe him becoming pale, collapsing, and quickly regaining consciousness. There was no convulsion or post-ictal confusion. He had skipped breakfast and felt hot and lightheaded before the episode.

What is the MOST likely diagnosis?

Helen Bradbury, aged 65, presents with increasing right-hand clumsiness and weakness. Examination reveals hyperreflexia, spasticity in the lower limbs, and muscle wasting with fasciculations in the upper limbs. Sensory examination is normal.

What is the MOST likely diagnosis?

Jasmine Kaur, aged 38, presents with double vision that worsens through the day and improves with rest. She also has drooping of the left eyelid by the evening. Examination reveals fatigable ptosis and normal pupils.

What is the MOST likely diagnosis?

Dylan Fahey, aged 59, presents with burning pain and numbness in both feet that has gradually progressed over 6 months. He has type 2 diabetes and drinks 6 beers daily. Examination reveals decreased pinprick and vibration sense in a stocking distribution.

What is the MOST likely diagnosis?

Catherine Nguyen, aged 49, presents with vertigo, nausea, and vomiting that began acutely this morning. She has no hearing loss or tinnitus. Examination reveals unidirectional horizontal nystagmus and positive head impulse test.

What is the MOST likely diagnosis?

Andrew Gilbert, aged 73, presents with a one-week history of new-onset confusion, headache, and low-grade fever. On examination, he is disoriented and has a Glasgow Coma Score of 13. Kernig’s and Brudzinski’s signs are negative. CT brain is unremarkable. CSF shows lymphocytosis, elevated protein, and normal glucose.

What is the MOST likely diagnosis?

Karen Hoy, aged 61, presents with a sudden, severe thunderclap headache while gardening. She has neck stiffness and photophobia. On examination, her GCS is 15 and cranial nerves are intact. CT brain is normal.

What is the MOST appropriate next step in investigation?

Felix Dawson, aged 47, presents with slowly progressive difficulty swallowing, nasal speech, and weakness of the hands. On examination, there is tongue fasciculation and mixed upper and lower motor neuron signs in all limbs. Sensation is intact.

What is the MOST likely diagnosis?

Dominic Brooks, aged 37, presents with brief episodes of vertigo triggered by rolling over in bed. The episodes last less than one minute and resolve spontaneously. Dix-Hallpike manoeuvre reproduces symptoms with nystagmus.

What is the MOST appropriate treatment?

Linda Barros, aged 30, presents with weakness in the right arm and leg, blurred vision in the left eye, and urinary urgency. Symptoms have progressed over several days. Past history reveals a similar episode 2 years ago that resolved spontaneously. MRI brain shows multiple periventricular white matter lesions.

What is the MOST likely diagnosis?

Benjamin Hsu, aged 54, presents with right-sided hemiparesis and expressive aphasia. His symptoms began 9 hours ago. CT brain shows an established infarct in the left middle cerebral artery (MCA) territory. He has a history of hypertension and atrial fibrillation.

What is the MOST appropriate secondary prevention strategy?

Fiona Hart, aged 29, presents with weakness and tingling in both legs that started suddenly after lifting a heavy object. She reports urinary incontinence and numbness in the saddle area. Examination reveals reduced anal tone and absent lower limb reflexes.

What is the MOST appropriate next step?

Rachel Law, aged 72, presents with fluctuating confusion, visual hallucinations, and tremor. Her daughter reports she has become more unsteady recently. MMSE is 21/30. Symptoms have been progressing for 6 months.

What is the MOST likely diagnosis?

Omar Kanaan, aged 38, presents with recurrent episodes of severe left-sided periorbital pain lasting 30–60 minutes. During attacks, he experiences lacrimation and nasal congestion. The headaches occur nightly over several weeks, then remit for months.

What is the MOST appropriate acute treatment for his attacks?

Anika Joshi, aged 52, presents with a history of poorly controlled hypertension and a sudden onset of right-sided weakness and slurred speech. CT brain reveals a left basal ganglia haemorrhage.

What is the MOST important acute management priority?

Claire Jamison, aged 47, presents with fatigue and cramping in her hands, especially after prolonged activity. She also notes occasional double vision in the evenings. Examination reveals ptosis that worsens with sustained upgaze and proximal muscle weakness in the arms.

What is the MOST appropriate initial investigation?

Timothy Rogers, aged 66, presents with burning foot pain and reduced sensation to vibration and pinprick in a stocking distribution. He has a 15-year history of type 2 diabetes and recently started chemotherapy for colon cancer.

What is the MOST likely cause of his symptoms?

Natalie Cheng, aged 40, presents with intermittent episodes of tingling and weakness in her right arm. She also reports neck pain that radiates to her shoulder. Spurling’s test reproduces her symptoms. Reflexes and strength are slightly reduced on the affected side.

What is the MOST likely diagnosis?

Jason Leonard, aged 72, presents with recent onset of imbalance, intention tremor, and wide-based gait. He has a history of chronic alcohol use. Examination shows dysmetria and nystagmus.

What is the MOST likely cause of his symptoms?

Sasha Grant, aged 34, presents with numbness and weakness in the right hand. She is a dental hygienist and reports frequent wrist flexion. Examination reveals decreased sensation in the 4th and 5th fingers and weakness in finger abduction.

What is the MOST likely site of nerve compression?

Harriet Bell, aged 61, presents with a three-day history of worsening right-sided facial droop and inability to close her eye. She is unable to wrinkle her forehead on the affected side. There is no limb weakness, fever, or rash. Her past medical history includes type 2 diabetes and hypertension.

What is the MOST appropriate initial management?

Larry Thompson, aged 55, presents with recurrent episodes of vertigo lasting seconds, brought on by turning his head. He feels unsteady but has no hearing loss or tinnitus. Dix-Hallpike manoeuvre reproduces symptoms with rotatory nystagmus.

What is the MOST likely diagnosis?

Amelia Knox, aged 28, presents with sudden-onset right eye pain and blurred vision. The pain worsens with eye movement. On examination, there is a relative afferent pupillary defect, decreased visual acuity and normal fundoscopy. She had a similar episode 18 months ago affecting the left eye.

What is the MOST likely underlying diagnosis?

Leon Tan, aged 42, presents with difficulty relaxing his grip after holding tools tightly. He also reports facial weakness and has a family history of similar symptoms. Examination reveals distal muscle wasting, ptosis, and delayed hand opening after grip.

What is the MOST likely diagnosis?

Jonathon Rice, aged 71, presents with progressive lower back pain, bilateral leg weakness, and urinary retention. He has reduced perianal sensation and decreased anal tone. MRI shows compression of the cauda equina.

What is the MOST appropriate next step in management?

Olivia Dalton, aged 64, presents with gradual-onset numbness and tingling in both feet and difficulty with balance in the dark. She has a vegetarian diet and drinks minimal alcohol. Examination shows decreased vibration and proprioception in the feet, positive Romberg sign, and brisk reflexes.

What is the MOST likely cause of her symptoms?

Nicholas Reid, aged 50, presents with headaches, personality change, and seizures over the past 2 months. He has developed progressive left-sided weakness. MRI brain reveals a ring-enhancing lesion in the right frontal lobe with surrounding oedema.

What is the MOST likely diagnosis?

Hayley Zhou, aged 34, presents with progressive bilateral hearing loss, imbalance, and facial numbness. Examination reveals bilateral reduced corneal reflexes and nystagmus. MRI reveals bilateral cerebellopontine angle masses.

What is the MOST likely diagnosis?

Edward Lin, aged 75, presents with acute onset right facial weakness, dysarthria, and left-sided limb weakness. CT brain shows a left pontine infarct.

What is the MOST likely underlying syndrome?

Fatima Karim, aged 36, presents with fatigue, muscle cramps, and tingling around her mouth. She recently had a total thyroidectomy. ECG shows prolonged QT interval. Chvostek’s and Trousseau’s signs are positive.

What is the MOST likely cause of her symptoms?

Isla Morrison, aged 48, presents with recurrent episodes of left-sided throbbing headache associated with nausea, photophobia, and visual aura. The episodes last for several hours and she is symptom-free between attacks. Neurological examination is normal.

What is the MOST likely diagnosis?

Jacob Ferreira, aged 65, presents with resting tremor in his left hand, slowness in movement, and rigidity. He has trouble initiating walking and his handwriting has become smaller. There is no history of antipsychotic medication use.

What is the MOST likely diagnosis?

Rachel Sun, aged 39, presents with sudden onset of vertigo, diplopia, and dysarthria. She also has unsteadiness and left-sided facial numbness. Her past history includes smoking and hypertension. Examination reveals left-sided Horner’s syndrome and limb ataxia.

What is the MOST likely diagnosis?

Paul Nguyen, aged 60, presents with weakness in his hands and difficulty walking. His symptoms have progressed over the past year. On examination, he has brisk reflexes, spasticity in the legs, and muscle wasting in the hands. Sensory exam is normal.

What is the MOST likely diagnosis?

Ellie Tran, aged 26, presents with episodes of sudden involuntary jerking movements of her arms, mostly in the morning shortly after waking. She also had a generalised tonic-clonic seizure last month. EEG shows 4–6 Hz polyspike and wave discharges.

What is the MOST likely diagnosis?