(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

The patient is a 53-year old male who presented to the emergency room with a five day history of worsening rash, pain and swelling in his right hand that had progressed to include facial and left hand involvement.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

The patient is a 53 year old male who presented with intermittent fevers, night sweats, and a chronic cough. The patient underwent a PET scan, which showed an enlarged supraclavicular lymph node, a lesion in the left lobe of his liver and bulky retroperitoneal lymphadenopathy. His peripheral blood showed a normocytic normochromic anemia with leukocytosis. The patient underwent excision of the supraclavicular lymph node.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 53-year-old male was found to have leukocytosis and a neutrophilic left shift on routine blood work (Image 1).

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 53-year-old obese man was transferred to the hospital with new onset seizures and a left frontal intracranial tumor diagnosed by a CT scan. The preceding medical history was significant for chronic obstructive pulmonary disease, asbestos exposure, 30-pack-years of tobacco use and chronic alcoholism.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

The patient was a 53 year-old man who presented with confusion and amnesia and subsequently suffered rapid progressive cognitive decline over the next few weeks associated with myoclonic jerks. His condition did not improve and he expired just over 3 years after presentation. The patient had a past medical history of adult onset generalized epilepsy beginning the third decade of life. Initially the cognitive decline, myoclonic jerks and epilepsy were not thought to be linked and a clinical diagnosis of Creutzfeldt-Jakob disease was made based on the age of onset symptoms and the aggressive nature of the disease.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 53 year old man presented with a cyst on his left cheek. The lesion was excised and submitted with a postoperative diagnosis or "epidermal inclusion cyst."

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 53-year-old white male with a history of alcohol abuse and pancreatitis presented to the emergency department with a 6-month history of nausea, vomiting and weight loss. One month prior, he had been diagnosed with cirrhosis of the liver, and subsequently hospitalized twice with removal of two and then five liters of ascites fluid. He developed significant abdominal pain associated with nausea and vomiting. He also had difficulty tolerating oral intake and constipation. He was not eating but sustaining himself on fluids. On physical examination, the patient was not jaundiced, but his abdomen was distended with a positive fluid wave. A firm mass was noted in the left mid epigastrium judged consistent with splenomegaly. His total bilirubin was 0.5 (direct 0.1), alkaline phosphatase 102, ALT 27, AST 17, albumin 3.4, total protein 6.3, prothrombin time 9.4, INR 1, partial thromboplastin time 33.8, amylase 257 and lipase 1130. He was admitted with a diagnosis of acute pancreatitis. He was made n.p.o. and given IV fluids.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 53-year-old woman presented with a 1-month history of severe headache and intractable vomiting. Physical examination revealed left facial palsy and generalized weakness of the extremities (grade IV/V all extremities) without other localizing signs. She had no known underlying disease and there was no significant family history. MRI of the brain disclosed multiple ill-defined high signal lesions in T2W at left lower pons, left thalamus, subcortical regions of temporal, parietal, and frontal lobes bilaterally, and periventricular white matter. Nodular enhancement was noted in the left frontal lobe lesion (Figure 1), left thalamus (not shown) and left pons (Figure 2). Irregular leptomeningeal enhancement was also noted diffusely. The largest mass present at the left frontal lobe was 2 cm in largest dimension and showed marked peritumoral vasogenic edema (Figure 1). High resolution chest CT revealed an ill-defined mass at the posterior basal segment of the right lower lobe, 3.2 cm in greatest dimension (not shown). There were also multiple small nodules involving both lungs, ranging from 0.4 to 0.5 cm. Stereotactic biopsy of the left frontal lobe lesion was performed.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 54-year old male presented with left vision loss, headache and left-sided facial pain. On physical examination medial and inferior displacement of the left eye was noted. He had a remote history of intracranial surgeries 17 and 5 years prior to this admission which included a left frontotemporal craniectomy, partial resection of the left anterior temporal lobe and sinonasal surgeries. Magnetic resonance post-contrast images showed enhancing lesions on the left side adjacent to the optic nerve, in the anterior temporal lobe, fronto-ethmoid sinus (Figure 1A), parasellar region, skull base, right dura, nasal cavities, and nasopharynx. A body positron emission tomography scan demonstrated evidence of tumor in the left deep cervical lymph nodes. Eight months later, intradural masses were noted in the cauda equina, thoracic paravertebral region and in the lumbar vertebral bodies. The nasopharyngeal mass was biopsied.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A fifty-four year old female with past medical history of pulmonary hypertension, fibromyalgia, chronic obstructive pulmonary disease, coronary artery disease and hypertension presented to the emergency department with complaints of increased dyspnea, lower extremity edema, weight gain, orthopnea, fevers, chills, night sweats over the past few months. She denied any cough or sputum production. The patient was on trepostinil (remodulin) infusion since 3 years. She had a history of line infection two years ago which was successfully treated with antibiotics. Patient had a right subclavian port placed about ten months ago. Her other medications included estrogen, escitalopram, warfarin and gabapentin. The patient did have a remote history of smoking although she had quit smoking eight years prior. She denied any drug allergies, alcohol or intravenous drug abuse.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

This is a 54-year-old white male with a history of polymyositis, type 1 diabetes mellitus, and hypothyroidism who has been on immunosuppression with methotrexate and prednisone. He presented with an episode of vomiting, headache, memory loss, cognitive decline, and right lower extremity weakness and numbness that lasted for about four hours, three days prior to admission. The symptoms were resolved spontaneously after sleep.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 54 year-old man with past medical history significant for hypertension and gastro-esophageal reflux (GERD) presented with several months of sinus complaints (headaches, nasal drainage, sinus pain) requiring several courses of antibiotics and a right-sided tympanostomy tube placement. Over the last 2-3 months he developed bilateral eye pain with progressive vision loss, to the point of becoming blind in both eyes. He also had an unintentional weight loss of nearly 100 pounds. On physical examination no other motor, sensory, or cranial nerve deficits were seen. A CT scan of the brain showed a right frontoparietal subdural fluid collection, consistent with a hematoma, measuring up to 1 cm in thickness. This was associated with minimal midline shift and compression of the right lateral ventricle. A bilateral temporal artery biopsy and a turbinate biopsy showed no evidence of vasculitis. He underwent drainage of the hematoma without significant improvement of his symptoms. A brain MRI was performed. The T1 image revealed bilateral subdural collections, with associated diffuse meningeal thickening, (Figs 1, 2). There was a 1.5 cm lesion with restricted diffusion in the right parietal lobe and associated contrast enhancement, morphologically suspicious for a lymphoma. A FLAIR sequence showed no discrete mass corresponding to the area of restricted diffusion. In addition there was patchy mass-like effect, and mild herniation of the right parietal lobe into the burr hole.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 54-year-old woman with no significant medical history complained about nausea and vomiting. Her family reported personality changes over the past few weeks. Neurological investigation revealed paresis of the abducens and hypoglossal nerves on the left side, a right sided reduction of the visual field, as well as dysarthria and ataxia. Cranial MRI demonstrated an extensive circular meningeal lesion (2 cm x 3 cm) of the foramen magnum with contrast enhancement (Figures 1 and 2, arrows). The process compressed the medulla oblongata and ensheathed the spinal cord. Hydrocephalus of all ventricles was noted. The thoracic X-ray and a thyroid scintigraphy were normal. Ophthalmologic investigation revealed an edema of the left papilla. Serological tests for p- and c-ANCA, ANA, DNA, ENA and tumor markers were negative. The CSF showed signs of a chronic lymphocytic meningitis and was negative for Borrelia or mycobacteria. Because of circular growth, the tumor was resected only partially.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

The patient is a previously healthy 54-year-old woman with a 12 year history of anemia and recent (3 months) onset of pancytopenia of unknown etiology (leukocytes 2.5 x 109 /L, hemoglobin 7.8 gm/dL, platelets 30 x 109 /L). Her past medical history was unremarkable. The physical examination revealed moderate splenomegaly and was otherwise unremarkable. An abdominal computed tomography scan revealed splenomegaly. Additional laboratory examinations revealed a negative Coombs test, slightly elevated lactate dehydrogenase, and slightly increased haptoglobin. The spleen was removed and her pancytopenia resolved.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 55-year-old male presented to our institution in October, 2016 with a 4-week history of intermittent slight fever and 3-week headache, accompanied by dizziness as well as fatigue, nausea, tinnitus, vision rotation, standing instability and blurred vision. Physical examination revealed no focal neurological deficit. MRI showed a flaky and nodular lesion involving the right cerebellar hemisphere and cerebellar vermis. The lesion was isointense on T2 weighted images, high signal intensity on T1 weighted images with nodular gadolinium enhancement (Figures 1a, 1b). Laboratory investigations revealed a white-cell count of 9780 per mm3 (reference range, 3500 to 9500), and an absolute eosinophil count of 1660 per mm3 (reference range, 20 to 500). A biopsy of the lesion was performed. .

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 55-year-old male presented to the outpatient clinic with a combination of neurological symptoms for one month, including movement, speech and behavioral symptoms. MRI revealed in the axial T2 sequence a right frontal lobe mass, with surrounding white matter edema and local mass effect, compressing the right lateral ventricle, with a midline shift to the left (Fig. 1a). Furthermore, in the axial and coronal post gadolinium T1 sequences the mass demonstrated ring enhancement (Figs. 1b and 1c). A wide local excision was performed.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 55-year-old woman presented with headaches and dizziness for one and a half years. An initial lumbar puncture and MRI showed no relevant results. In the meantime, she experienced intermittent nausea and vomiting with significant weight loss. Shortly before she was referred to our institution she had for the first time a generalized seizure. A MRI scan now showed FLAIR-signal intense arachnoidea and partial diffuse contrast enhancement in the left central sulcus and sylvian fissures bilaterally as well as cerebral and spinal leptomeningeal enhancement (Figs. 1 and 2). There were no parenchymal lesions. A biopsy of one of the contrast enhancing parts of arachnoidea was planned. Unexpectedly, after opening the dura mater, it was noted that the cerebral surface was covered by densely pigmented black tissue. Three cortical biopsies were taken.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 55-year-old male patient presented with a half-month history of intermittent headache; no nausea, weakness, convulsion, fever, or any other symptoms were accompanied. His physical examination was normal. The neurologic examination did not reveal any abnormalities. Laboratory findings were unremarkable. The results of chest radiograph and abdominal ultrasonography were normal. Axial T1-weighted MRI of brain showed heterogeneous enhancement signal in the deep sites of left temporal and insula lobe (Figure 1A). FLAIR sequence showed the lesion was slightly hyperintensity signal surrounded by obvious edema (Figure 1B). Then, a glioma was highly suspected and an operation of subtotal resection was performed under neuronavigation.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 55-year-old male patient had a medical history of nephrotic syndrome and was followed up at a local hospital for many years. He had felt general fatigue for 2 years which became exacerbated 2 months ago. He visited our hospital where a series of laboratory tests showed hyponatremia and hypokalemia accompanied with low cortisol level. Other endocrinologic tests were within normal limits. After transsphenoidal adenomectomy, the patient developed panhypopituitarism, which has been managed by hormone substitution. No adjuvant therapy was administered. The patient made an uneventful recovery and has been receiving regular follow-up at our neurosurgery department without clinical or radiological evidence of a recurrent tumor for 7 years.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 55-year-old Brazilian man, with previous history of bariatric surgery developed acute weakness of his lower limbs that started six weeks prior to his admission. He started with paresthesias in lower limbs followed by ascending and asymmetrical paraparesis. He was unable to walk weeks later. He had no pain, no upper limbs weakness and no loss of bowel or bladder control. Physical examination revealed paraparetic gait, and flaccid asymmetric paraparesis (left > right). Deep tendon reflexes were absent in the legs, with indifferent plantar response. Electroneuromyography was consistent with an acute inflammatory demyelinating polyradiculoneuropathy (Guillain-Barré syndrome). MRI of neuroaxis showed diffuse nodular abnormalities of the leptomeninges, more pronounced in dural sac where formed intra-rachidian mass (Fig 1) and hemorrhagic extra-axial nodular lesions in posterior fossa, basal cisterns and subarachnoid space of cerebral hemispheres (Figs 2 and 3). A second MRI showed larger lesions and more of them (Figs 4 and 5) as well as a new cerebral hemorrhage (Fig 6). An extensive search for the primary site was negative (chest and abdominal CT, cervical and testicular ultrasonography). Cisternal puncture didn't reveal any neoplastic cells and immunophenotyping demonstrated normal lymphocytes. A biopsy of the lesion (dural sac) was performed.