Translated version of 12 Infectious diseases

of the nervous system.docx

First Moscow State Medical University named after IM
Sechenov
APPROVED

Vice Rector for Academic Affairs,
Professor A.A.Svistunov

Case studies on private neurology
Subject of neurology, neurosurgery
Course IV
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Topic 12: Infectious diseases of the nervous system.

Task 1.
A woman of 60 years in two days growing headache,
increased body temperature (up to 38,5 ), on the third day of
the disease develops convulsive seizure with loss of
consciousness for a few minutes. On examination: conscious,
but answers questions in monosyllables, complaining of a
severe headache, drowsiness, facing it understands, but the
patient's own voice has grammatical violations noted
"telegraphic" style of speech. Weakness of the lower part of the
right facial muscles, loss of strength in the right limbs up to 3
points higher on their muscle tone, tendon reflexes, and the
presence of symptoms Babinski.
1. Neurological syndromes?
Upper motor neuron (Central Paresis)
Monoparesis
2. Topical diagnosis?
3. Expected disease?
Viral encephalitis
4. Additional tests?
CSF examination
5. Treatment?
Acyclovir
Task 2.
A woman 65 years old having girdle pains in the right side
of the chest, after 3 days there were vesicular eruptions in this
area. Within a month the rash is completely gone, but feeling
pain in the chest that periodically increases and penalized nights
sleep. Acceptance of non-narcotic analgesics is not very
effective. The examination revealed the right areas of cutaneous
depigmentation in the chest, pain hypersensitivity at the 5-10th
thoracic segments on the right.
1. Neurological syndrome?
Hyperaethesia

2. Localization of defeat?
3. Expected disease?
4. Treatment?

Task 3.
Male 55 years old complained of headache, fever up to
38,0 C during the past three days, as well as numbness in the
left extremities, which occurred on the same day. On
examination: conscious, oriented in time and place, facing it is
not fully understood, in patient's speech marked verbal
paraphasias, easing pain and temperature sensitivity in the side
of the face, trunk and limbs left. In the study of cerebrospinal
fluid revealed lymphocytic pleocytosis (105 cells in 1 l), 0.44 g
of protein / l glucose level is normal.
1. Neurological syndromes?
2. Topical diagnosis?
3. Expected disease?
4. Additional tests?
5. Treatment?

Task 4.
Male 72 years complained of pain and rash in the right
frontal region, which appeared five days ago. The patient feels
almost healthy, in the last few years he has been a periodic
increase in blood pressure to 150/90 mm Hg The examination in
the right frontal region marked vesicular eruptions in this area
reveals a weakening of pain and temperature sensitivity, no
other violations.
1. Neurological syndromes?
2. Topical diagnosis?
3. Expected disease?
4. Additional tests?
5. Treatment, if confirmed presumptive diagnosis?

Task 5.
Male 25 years complained of worsening headache and
fever up to 37,5 C in the last two days. Before disease
considered himself almost healthy. On examination: clear
consciousness, oriented in space and time, stiff neck muscles,
Kernig on both sides, no other neurological disorders.
Diagnostic purposes patient underwent lumbar puncture. In the
study of cerebrospinal fluid was an increase in the number of
lymphocytes in 150 l of cell protein - 0,65 g / l glucose level is
normal.
1. Neurological syndrome?
2. Localization of defeat?
3. Expected disease?
4. Additional tests?
5. Treatment?

Task 6.
A man 65 years for two days bother growing headache and
fever up to 39 C. During the last year twice suffered from
pneumonia, was treated with antibiotics. On examination:
conscious, oriented in space and time, but answers questions in
monosyllables, quickly exhausted, a considerable degree of
rigidity of the neck muscles, Kernig on both sides, other
neurological disorders have been identified. Diagnostic purposes
patient underwent lumbar puncture obtained turbid liquor. In the
study of cerebrospinal fluid was an increase in the number of
cells in the cell 1450 l, 90% neutrophils, protein - 0.99 g / l of
glucose lowering.
1. Neurological syndrome?
2. Localization of defeat?
3. Expected disease?
4. Additional methods obsled5ovaniya?
5. Treatment?

Task 7.
Male 45 years old complained of weakness in the arms
and neck muscles. Two weeks ago, was on a business trip in
Tyumen, several times went hunting in the woods near the
town. By the end of said trip headache, fever. Later there was
also growing weakness in the muscles of the arms and neck. On
examination: mild stiffness of the neck muscles, weakness in
the muscles of the neck and proximal arms up to 3 points with a
decrease in muscle tone and loss of reflexes, no other
neurological disorders.
1. Neurological syndrome?
2. Localization of defeat?
3. Expected disease?
4. Additional methods obsled5ovaniya?
5. Treatment?

Task 8.
The young man of 18 years in the last three months are
marked with almost constant clonic spasms in the muscles of the
limbs and abdomen. During this period, it was also noted two
short seizure with loss of consciousness and tonic-clonic
seizures in the limbs. From history we know that six months
ago, went hiking with friends along the Irtysh, in this period was
bitten several times by a mite, the temperature increases (up to
37,5 C) and mild headache, the doctors did not address. The
examination light weakness in the left extremities to 4 points
with the recovery of tendon reflexes, Babinski symptom
presence. In the left extremities and abdomen periodically
observed clonic seizures and other neurological disorders not.
1. Neurological syndrome?
2. Localization of defeat?
3. Expected disease?
4. Additional tests?
5. Treatment?

Task 9.
A man 36 years old having pain in the back, then
weakness in the legs and the delay when urinating. From history
we know that 10 years ago was diagnosed with syphilis treated
by urologist familiar and, according to the patient, with a
positive effect. On examination: weakness in the legs up to 3
points, reflexes were brisk, Babinski on both sides, the positive
symptoms of nerve root tension (Lasegue, Wasserman), easing
joint and muscle sense and vibration sensation in the lower
limbs, no other neurological disorders.
1. Neurological syndromes?
2. Topical diagnosis?
3. Expected disease?
4. Additional tests?
5. Treatment?

Task 10.
A young man, age 22, bother growing headache and fever
up to 37 C for a week. Before disease considered himself
virtually healthy, of past diseases remembers only chickenpox
and measles in childhood, as well as rare acute respiratory viral
infections. On examination: cervical muscle rigidity, Kernig on
both sides, no other neurological disorders. When obtained by
lumbar puncture, CSF unclear, the composition of the
cerebrospinal fluid increase in the number of cells in 105 l (90%
lymphocytes), protein 0.65 g / l glucose level is normal, the
positive Wassermann reaction.
1. Neurological syndromes?
2. Topical diagnosis?
3. Expected disease?
4. Additional tests?
5. Treatment?

Task 11.
Male 25 years old during the month concerned worsening
headache and weakness in the left extremities. Before the
disease he considered himself virtually healthy, married
homosexual. On examination: the omission of the left corner of
the mouth, with a grin asymmetry (little skewed to the right
person), weakness in his left hand up to 3 points, at the foot of
up to 4 points with increased muscle tone, tendon reflexes,
Babinski symptom, no other neurological disorders . In the
blood test gave positive reactions to HIV infection and
toxoplasmosis. Magnetic resonance imaging head revealed
multiple foci of rounded (15-20 mm diameter) high intensity
signal in the T mode, and two low-intensity signal to the T-1
mode.
1. Neurological syndromes?
2. Topical diagnosis?
3. Expected disease?
4. Additional tests?
5. Treatment?

Target 12.
Man 45 years old, suffering from acquired immune
deficiency syndrome, complained of memory loss, difficulty
concentrating, slow thinking. Neuropsychological examination
revealed a slight decrease in memory disorders, gnosis, praxis,
and intelligence. In the neurological status revealed uniform
recovery of tendon reflexes, positive symptoms of oral
automatism, a slight increase in muscle tone type rigidity,
instability in a complicated sample Romberg.
1. Neurological syndromes?
2. Topical diagnosis?
3. Expected disease?
4. Additional tests?
5. Treatment?

Task 13.
A man 52 years old, suffering from pulmonary
tuberculosis, during the month of growing headache and general
weakness, there is an increase in body temperature to 37 C. On
examination: clear consciousness, oriented in space and time,
but answers questions in monosyllables, quickly exhausted, stiff
neck muscles, Kernig on both sides, no other neurological
disorders.
1. Neurological syndromes?
2. Localization of defeat?
3. Expected disease?
4. Additional tests?
5. Treatment?

Task 14.
The boy had three years of having first rise in temperature
to 37 C and diarrhea for several days, then the pain in the leg
muscles and weakness in them. With the words mom know that
due to allergic reactions to the boy were not carried out
preventive vaccination. On examination: weakness in the legs
up to 2 points with a decrease in muscle tone and loss of tendon
reflexes, no other neurological disorders.
1. Neurological syndrome?
2. Topical diagnosis?
3. Expected disease?
4. Additional tests?
5. Treatment?

Task 15.
A girl three years a week after being vaccinated against
polio developed pain and weakness in the legs. During the week
before the vaccination girl was ill of acute respiratory viral
infection, but the parents were not informed of this nurse
conducting preventive vaccination. On examination: weakness
in the legs up to 4 points with a slight decrease in muscle tone
and reflexes, no other neurological disorders.
1. Neurological syndrome?
2. Topical diagnosis?
3. Expected disease?
4. Additional tests?
5. Forecast?


Head. Univ. Professor V.A.Parfenov

Dean of the medical faculty professor V.V.Fomin