NeuroSurgery

🧠 YOUR DIAGNOSIS ?👩‍⚕️- A 50 Year old Male with no significant medical history reports at the Neurological department 🧠 complaining of a decrease in strength starting from the right arm and progressing to the right leg. This is also followed by the left leg and finally his left arm. He also complains of solid food dysphagia in the past week.

Physical Examination:
Glasgow Coma Scale: 15 Points
Gag Reflexes : Absent Bi-Laterally
Soft Palate: Deviated to the Left
Tetraparesis: 4/5
Hyperreflexia: Present in all for limbs
Babinski Sign: Present on the Right Lower Limb

What seems to be his diagnosis ?
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🇺🇸U$MLE $TEP 1:Pharmacology💊: NEXT BEST TREATMENT ? - [ Dr.Kevin Obeng-Marnu,MD ] ::
CA$E DETAiLS ..
A 7-Year old Girl 👧 with no prominent medical history presents to her local physician 👩‍⚕️ with fever 🥵, sore throat and painful 😖 lesions on her lips 👄 and tongue 👅 for the past 3 days. There are no other noticeable signs and symptoms, no sick contacts and is her first episode of such ailment.

What is the most appropriate treatment for this girl’s condition ?

[A] Oral Flucytosine
[A] Oral Cephalexin
[C] Observation Only
[D] Topical Nystatin
[E] Oral Acyclovir

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A 67-Year-Old Male 👴 Patient presents to the Neuro 🧠 department with extreme visual 👁️ and olfactory 👃 hallucinations reporting bugs 🐞 and creeping 🐛 organisms on the wall , approximately 8 days after taking new medications💊 after a heart attack 🫀 and stroke incident 14 days prior. Patient has never presented with any form of hallucinatory episodes prior to medication administration.

MEDICATIONS 💊 :
Atorvastatin 40mg, Furosemide 20mg , Clopidogrel 75mg, Empagliflozin 25mg, Metoprolol Tartrate 50mg, Amlodipine 5mg, Dabigatran Etexilate 110mg ..

Which of the Following Medication is the most Likely Culprit of the Patient's Hallucination ?

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U$MLE🇺🇸$TEP 2CK - “ MOST APPROPRIATE NEXT STEP IN TREATING PATIENT ?. “ :-: CLU€ 🕵️‍♀️- Skin & Soft Tissue Infection “.. 👨‍⚕️[Dr.Kevin Obeng-Marnu,MD] — [NeuroSurgery] …
CA$E D€TAiLS…
A 32-Year old Caucasian Female 👩 Patient with no notable previous medical history or chronic illness comes to the Clinic 🏥 with painful 😓 skin lesions affecting her back, chest and thighs.
The lesions appeared rather suddenly and she reports no preceding traumatic events ( e.g insect 🐜 🐞 bites ) , exposure to brackish water 💦 or immersion in hot tubs 🛁

Based on the patient’s medical history and image , what is the most appropriate next step of management ?

[A] Initial Trimethoprim-Sulfamethoxazole for MRSA 💊
[B] Drain lesion and send purulent material for culture and susceptibility
[C] Initiate empirical treatment for MRSA with Amoxicillin 💊
[D] Arrange for In-Patient admission and Intravenous Antibiotics Infusion

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Follow to Support our “ NEUROSURGERY “ Channel on WhatsApp Opened Today .. Learn More about your Human Brain 🧠 Thanks 🙏 .. Click on Link below 👇 ⬇️

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🇺🇸U$MLE $TEP 2CK - “ NEXT BEST STEP OF MANAGEMENT? “- CLUE🕵️‍♀️ - AGE of Patient : - KEYWORD 🔐- Unilateral Effect.. 👨‍⚕️[ Dr.Kevin Obeng-Marnu,MD ] … [ NeuroSurgery ] ..
CA$E DETAiLS
A 37 year old cis African-American man appears at the medical center following a respiratory infection. During cross examination a pale-gray ring around the right cornea with the lucid interval of Vogt present showing a small distance between the Iris and the Limbal ring.

This is a Unilateral effect with the left eye observed to be normal. Patient has a history of alcohol use, smoking and early cardiac disease in family members.

After addressing the upper respiratory, What will be the next best step in Management ?

[A] Perform a Ceruloplasmin Test
[B] Perform a Carotid Artery Doppler Ultrasound
[C] Perform a Vision Test
[D] Perform a Gamma-Glutamyl Transferase Test

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WHAT IS CAROTID ARTERY DISEASE ? : 👨‍⚕️[ Dr.KevinMarnu USMLE 🇺🇸]- [ NeuroSurgery ] ..
The carotid arteries are the main blood vessels that send blood and oxygen to the brain. When these vessels become narrowed, it’s called carotid artery disease. It may also be called carotid artery stenosis. The narrowing is caused by atherosclerosis. This is the buildup of fatty deposits, calcium, fibrous tissue and other cell debris that lines the inside of the artery.. Carotid artery disease is like coronary artery disease. In that disease, buildup occurs in the arteries of the heart. That may cause a heart attack.

Carotid artery disease reduces the flow of oxygen to the brain. The brain needs a constant supply of oxygen to work. Even a brief pause in blood supply can cause problems. Brain cells start to die after just a few minutes without blood or oxygen. If the narrowing of the carotid arteries is severe enough that blood flow is blocked, it can cause a stroke. If a piece of plaque breaks off it can block blood flow to the brain. This too can cause a stroke.

CAUSES AND RISK FACTORS ?
There are several factors that can increase your chance of developing this condition over time. Some of these are factors you can change. Some contribute to and compound other factors:

Smoking and using to***co products.
Having obesity.
Sedentary lifestyle.
High blood pressure (hypertension).
High cholesterol.
Diabetes.
Age.

SYMPTOMS
In its early stages, carotid artery disease often doesn't have symptoms. The condition might not be obvious until it's serious enough to deprive the brain of blood, causing a stroke or TIA.

Symptoms of a stroke or TIA include:

Sudden numbness or weakness in the face or limbs, often on one side of the body.
Sudden trouble speaking and understanding speech.
Sudden trouble seeing in one or both eyes.
Sudden dizziness or loss of balance.
Sudden, severe headache with no known cause.

DIAGNOSIS
To diagnose carotid artery disease, we perform a physical exam. We’ll specifically listen to the blood flow in your neck for a bruit. Your doctor may also have you see a neurologist, who can check for signs of a stroke or TIA.
To assess your overall health and likelihood of carotid artery stenosis, we may order blood tests to check your blood sugar, cholesterol and triglycerides.
Your doctor may also order imaging tests to examine the blood vessels in your brain and neck. We perform many of these tests in our renowned vascular testing and diagnosis labs. Your tests may include:
Cerebral angiography: Maps the blood vessels in your brain
CT angiography (CTA): Uses a contrast material (dye) and a series of X-rays to show detailed images of blood vessels
MR angiography (MRA): Uses a strong magnetic field to show clear images of a carotid artery blockage
Ultrasound of the carotid arteries (carotid duplex ultrasound): Checks how your blood flows through the carotid artery

TREATMENT
If a carotid artery is less than 50% narrowed, it is often treated with medicine and lifestyle changes. If the artery is between 50% and 70% narrowed, medicine or surgery may be used, depending on your case.

Medical treatment for carotid artery stenosis may include:

Lifestyle changes

Quit smoking. Quitting smoking can reduce the risk for carotid artery stenosis and cardiovascular disease. All ni****ne products, including electronic ci******es, constrict the blood vessels. This decreases blood flow through the arteries.
Lower cholesterol. Eat a low-fat, low-cholesterol diet. Eat plenty of vegetables, lean meats (avoid red meats), fruits, and high-fiber grains. Avoid foods that are processed, and high in saturated and trans-fats. When diet and exercise are not enough to control cholesterol, you may need medicines.
Lower blood sugar. High blood sugar (glucose) can cause damage and inflammation to the lining of the carotid arteries. Control glucose levels through a low-sugar diet, and regular exercise. If you have diabetes, you may need medicine or other treatment.
Exercise. Lack of exercise can cause weight gain and raise blood pressure and cholesterol. Exercise can help maintain a healthy weight and reduce risks for carotid artery disease.
Lower blood pressure. High blood pressure causes wear and tear and inflammation in blood vessels increasing the risk for artery narrowing. Blood pressure should be below 140/90 for most people. People with diabetes may need even lower blood pressure.
Medicines

Medicines that may be used to treat carotid artery stenosis include:

Antiplatelets. These medicines make platelets in the blood less able to stick together and cause clots. Aspirin, clopidogrel, and dipyridamole are examples of antiplatelet medicines.
Cholesterol-lowering medicines. Statins are a group of cholesterol-lowering medicines. They include simvastatin and atorvastatin. Studies have shown that certain statins can decrease the thickness of the carotid artery wall and increase the size of the opening of the artery.
Blood pressure-lowering medicines. Several different medicines work to lower blood pressure.
If a carotid artery is narrowed from 50% to 69%, you may need more aggressive treatment, especially if you have symptoms.

Surgery is usually advised for carotid narrowing of more than 70%. Surgical treatment decreases the risk for stroke after symptoms such as TIA or minor stroke.

Surgical treatment of carotid artery stenosis includes:

Carotid endarterectomy (CEA). This is surgery to remove plaque and blood clots from the carotid arteries. Endarterectomy may help prevent a stroke in people who have symptoms and a narrowing of 70% or more.
Carotid artery angioplasty with stenting (CAS). This is an option for people who are unable to have carotid endarterectomy. It uses a very small hollow tube, or catheter, that is thread through a blood vessel in the groin to the carotid arteries. Once the catheter is in place, a balloon is inflated to open the artery and a stent is placed. A stent is a thin, metal-mesh framework used to hold the artery open.

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🇺🇸USMLE $TEP 2CK :-: PATIENT MANAGEMENT ? - CLU€: “ Purpuric vesiculobullous lesions “ .. 👨‍⚕️[ Dr.Kevin Obeng-Marnu,MD ] - [ NeuroSurgery ] ..
CASE DETAiLS
A 47-year-old patient with psoriasis, chronic venous insufficiency, and venous ulcers presents with a one week history of purpuric vesiculobullous lesions affecting the lower extremities and distal forearms. The distal lesions have central necrosis with scattered erosions. The patient says the lesions itch and complains of mild abdominal pain and arthralgias.

Based on the locations of the lesions, the age of the patient, and the reported symptoms, how should the patient be managed?

[A] CBC and CMP
[B] Urinalysis (UA)
[C] Topical Corticosteroids and Ibuprofen
[D] Intravenous Antimicrobial
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🇺🇸U$MLE $TEP 3 : “😱 BASEBALL ⚾️ BAT INJURY !! “ : CLU€ :- Decreased Cerebral 🧠 Perfusion ? “ - 👨‍⚕️ [ Dr.Kevin Obeng-Marnu,MD ] : [ NeuroSurgery ] ..
CA$€ D€TAiLS ..
A 23 Year old African-American Female 👩 was attacked outside of the city grocery store with a baseball bat and was rushed to the emergency department by paramedics 🚑. She presents with multiple scalp lacerations, orbital fractures, and retrobulbar hemorrhage🩸due to the blunt force trauma by the assault weapon. Although the patient seems awake and alert [ Initial GCS of 14 ] but becomes extremely agitated while being stabilized, requiring restraints and deep sedatives. Below are some of the initial head images of the patient.

Which of the following is your primary concern in the acute management of this patient ?

[A] Cognitive Dysfunction
[B] Sensory Impairment
[C] Motor Impairment
[D] Intracranial Pressure
[E] Traumatic Axonal Injury
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WHAT IS MARFAN SYNDROME 👨‍⚕️[ Dr.Kevin Obeng-Marnu,MD ] - [ Dr.KevinMarnu USMLE 🇺🇸] ?? Is an inherited disorder that affects connective tissue — the fibers that support and anchor your organs and other structures in your body. Marfan syndrome most commonly affects the heart, eyes, blood vessels and skeleton.

People with Marfan syndrome are usually tall and thin with unusually long arms, legs, fingers and toes. The damage caused by Marfan syndrome can be mild or severe. If your aorta — the large blood vessel that carries blood from your heart to the rest of your body — is affected, the condition can become life-threatening.

Who does Marfan syndrome affect?

Marfan syndrome is fairly common, affecting 1 in 10,000 to 20,000 people. It has been found in people of all races and ethnic backgrounds.

Symptoms
Abnormally long fingers common in Marfan syndrome
Finger length in Marfan syndrome Open pop-up dialog box
Young woman having the length of her arm span measured
Longer arms in Marfan syndrome Open pop-up dialog box
The signs and symptoms of Marfan syndrome can vary greatly, even among members of the same family, because the disorder can affect so many different areas of the body. Some people experience only mild effects, but others develop life-threatening complications.

Marfan syndrome features may include:

Tall and slender build
Disproportionately long arms, legs and fingers
A breastbone that protrudes outward or dips inward
A high, arched palate and crowded teeth
Heart murmurs
Extreme nearsightedness
An abnormally curved spine
Flat feet

Brain aneurysms are caused by a weakness in the walls of blood vessels in the brain. There are several reasons why this may happen, although an exact cause isn't always clear.

The brain requires a large supply of blood delivered via the main blood vessels that run up the neck and into the brain.

These blood vessels divide into smaller and smaller vessels in the same way the trunk of a tree divides into branches and twigs.

Most aneurysms develop at the points where the blood vessels divide and branch off, as these areas are often weaker.

Increased risk

There are a number of things that can increase your risk of developing a brain aneurysm. These are discussed here.

Smoking

Smoking to***co can significantly increase your risk of developing a brain aneurysm.

Studies show the majority of people diagnosed with a brain aneurysm smoke, or have done so in the past.

The risk is particularly high in people with a family history of brain aneurysm.

Exactly why smoking increases the risk of brain aneurysms is unclear. It may be that the harmful substances in to***co smoke damage the walls of your blood vessels.

High blood pressure

High blood pressure can place increased pressure on the walls of the blood vessels inside the brain, potentially increasing your chances of developing an aneurysm.

You're more likely to develop high blood pressure if you:

are overweight
have a relative with high blood pressure
are of Black African or African Caribbean descent
eat a lot of salt
don't eat enough fruit and vegetables
don't do enough exercise
drink a lot of coffee or other caffeine-based drinks
drink a lot of alcohol
are aged over 65

BODY TISSUES DISORDER [ MARFAN SYNDROME & BRAIN 🧠 ANEURYSMS ]

Your risk of developing a brain aneurysm can be higher if you have a condition that affects your body tissues, such as Ehlers-Danlos syndrome or Marfan syndrome.

This is because these conditions can sometimes cause weaknesses in the walls of your blood vessels.

How is Marfan syndrome treated?

Not everyone with Marfan syndrome has all of the complications. People with Marfan syndrome must be closely followed by their doctor to watch for the following complications:

Heart disease, including aortic aneurysms and problems with heart valves
Bone deformities such as scoliosis (a curved spine) or a breastbone that is sunken or sticks out
Eye conditions that can lead to blurred vision or loss of sight, such as a retinal detachment (where the retina—the part of the eye that senses light in the back of the eye—peels away from its supporting tissue) or dislocation of the lens (where the lens shifts out of place)
Teeth that are crooked or crowded together, which might require dental procedures
A collapsed lung, which makes breathing difficult
Treatment depends on which parts of the body are affected. An aortic aneurysm may be treated with medicine or medicine plus surgery. Medicine is used to lower blood pressure to help prevent an aneurysm from rupturing and causing a dissection of the aorta.2

Severe scoliosis and breastbone problems may require surgery. Eye conditions may also require surgery.
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🇺🇸U$MLE $TEP 1 - “ Cause of this conjunctivitis? “.. CLU€ - “ Crust & Skin Involvement. “.. 👨‍⚕️ [ Dr.Kevin Obeng-Marnu,MD ] .. [ NeuroSurgery ] ..
CA$E DETAiLs..
A 32-year-old Man 👨 comes to the Ophthalmology 👁️ Clinic complaining of eye redness and discharge. The patient was originally seen for fever and malaise, which the physician attributed to a common cold; and also diagnosed with conjunctivitis. However, the patient complains of pain and inflammation in the eyes 👀 that worsens despite the use antibiotic eyedrops.

Physical examination reveals swelling of the eyelids , crust buildup, and a rash on the arm with skin sloughing. A review of the patient’s medical history reveals a recent head trauma that resulted in epilepsy which is being managed with a neurologist.

Which of the following underlying condition may best explain the ocular and cutaneous symptoms?

[A] Diabetes
[B] Retinitis Pigmentosa
[C] Herpes Simplex
[D] Stevens-Johnson syndrome
[E] Contact dermatoconjunctivitis

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🇺🇸 U$MLE $TEP 2CK - “ NEXT BEST STEP TO DIAGNOSE ? “- CLUE🕵️‍♀️ :-: “ SALTY🧂FOODS 🍱 CRAVING ? “ - 👨‍⚕️ [ Dr.Kevin Obeng-Marnu,MD ] .. [ NeuroSurgery ] ..
CA$E D€TAiLs
A 35 Year old PhD Student reports to his Physician due to a 4.5Kg [10 Ib ] weight loss over the past 2 Months with Nausea, vague abdominal pain, dizziness and syncopal episodes. Upon Questioning he admits craving for french fries 🍟 and other salty 🧂 foods 🍱. His colleagues have commented that his skin is a little tan than before but denies traveling 🧭 outside his locality lately and was previously healthy. Patient experiences no night sweats, fevers, chills, hair loss, dyspnea, heat or cold intolerance. His Temperature is 37°C [ 98.6°F ] , Pulse is 80/min, Respirations are 12/min, and blood pressure is 105/65 mmHg sitting and 85/45 mmHg standing, with Orthostatic dizziness. Hyperpigmentation of his palms are prominent and photograph from his oral examination is shown below 👇 .

Which of the following is the most appropriate next step in diagnosis?

[A] MRI of the Brain
[B] CT Scan of the Abdomen
[C] 24-hour Urinary Cortisol Excretion
[D] Fasting Glucose Level
[E] Serum Cortisol Level
[F] Complete Blood Count with differential and reticulocyte count

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🇺🇸U$MLE $TEP 1 :-: WHAT DNA 🧬 MUTATION ? : “ CLUE🕵️‍♀️ = FREQUENT FALLS “.. 👨‍⚕️[ Dr.Kevin Obeng-Marnu,MD ] ..
CA$E DETAiLs..
An 11 Year Old Female 👧 is brought to the NeuroSurgery 🧠 department for evaluation due to an unsteady gait. Although she has a history of long standing recurrent respiratory infections , her parents are more concerned about their daughter’s frequent loss of proprioception and falls and slower language developmental skills.
Physical examination reveals several scattered superficial blanching nests of distended blood vessels on sun exposed areas as well as her eyes 👀. Additionally her eyes and head do not move smoothly at the sight of motion objects. An MRI is taken to further confirm her diagnosis as shown in the images below👇 .
A Mutation in which of the following Tumor Suppressor Gene is responsible for the Patients Disorder ?

[A] p53
[B] ATM
[C] BRCA1
[D] RET
[E] BCL-2
[F] kRAS
[G] WT-1
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🇺🇸U$MLE $TEP 2CK :-: BATTERY🔋INGESTION ! WHAT’S NEXT ?- “ CLUE - LITHIUM POISONING “-👨‍⚕️[ Dr.Kevin Obeng-Marnu,MD ] [ NeuroSurgery ] .
CASE DETAiLS..
A 5-Year old boy 👦 suspected to have ingested a battery🪫 45 mins prior was brought to the emergency department by his parents. A remote control was found next to the boy 👦 with the battery🔋 cover open and battery missing as the parents elaborated. The boy’s siblings recounted to parents seeing a shiny ✨ round substance on the floor , as the boy 👦 picked up and ate it .
The Child is now drooling 🤤 struggling to breathe and swallow any food or drink .

X-Ray 🩻 image shown below👇 was taken. Anteroposteriorly shows a “ Halo-Sign “ button battery 🪫 visibility .

What is the NEXT BEST STEP of Management ?

[A] Administer IPECAC
[B] Administer EDTA
[C] Admit the Patient for Observation
[D] Administer Penicillamine
[E] Perform an Endoscopy
[F] Administer Succimer
[G] Prescribe NPO and Discharge the Patient
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🇺🇸U$MLE $TEP :-: Pruritic Painful😖Skin Bullae & Eruptions ? YOUR DIAGNOSIS?.. “ CLU€🕵️‍♀️= ANTI-DESMOGLEIN 3 or HEMIDESMOSOMES ANTIBODIES .. “ … 👨‍⚕️ [ Dr.Kevin Obeng-Marnu,MD ] .. [ NeuroSurgery ] ..
CA$E DETAiLS..
A 60-Year old man👴 with unknown medical history reports to the emergency department 🏥 with pruritic, painful 😣 tensed bullae, skin eruptions affecting his scalp , ears👂, arms , legs🦵, trunk but his face is spared.
Patient denies photosensitivity but explained that rash started 8 months prior starting from his legs🦵 . A Local dermatologist prescribed him 20mg prednisone q.d , but patient never received any definitive diagnosis.

What is the most likely Diagnosis based on the images below 👇 and Clinical symptoms..

[A] Pemphigus Vulgaris
[B] Acute Intermittent Porphyria
[C] Porphyria Cutanea Tarda
[D] Bullous Pemphigoid
[F] Dermatitis Herpetiformis
[G] Erythema Multiforme
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🇺🇸U$MLE $TEP :-: LOCATION FOR METASTASIS? - “ CLUE🕵️‍♂️ = Uveal Melanoma “.. 👨‍⚕️[ Dr.Kevin Obeng-Marnu,MD ] .. [ NeuroSurgery ] ..
CA$E DETAiLS ..
A 70 Year old Man 👴 reports to his local Physician 👩‍⚕️ of progressively deteriorating vision of the left eye 👁️ over the past few months. He complains of a sense of sensation that something is frequently stuck in his eye 👁️ and is often irritated. A Diagnosis of Choroidal Melanoma is established after thorough physical examination 🧐 and testing .

This Neoplasm is likely to First Metastasize to which of the following Organs ?

[A] Bones 🦴
[B] Kidney
[C] Liver
[D] Lungs 🫁
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