A 28-year-old male presents to the emergency department after falling off his bicycle and landing on his right arm. He complains of severe right arm pain and difficulty moving his wrist and fingers. On physical examination: • Swelling and deformity over the midshaft of the right humerus • Inability to extend the wrist and fingers • Weakness in thumb abduction • Intact elbow extension and shoulder movements • Decreased sensation over the dorsum of the hand An X-ray of the right arm confirms a midshaft humerus fracture. Question: Which of the following is the most likely nerve injury associated with this patient’s condition?
A 35-year-old male presents to the clinic with gradual onset of shoulder pain and weakness over the past few months. He is an avid weightlifter and frequently performs overhead movements and heavy lifting. He denies trauma or recent infections. On examination, there is: • Weakness in shoulder abduction (first 15 degrees) • Weakness in external rotation of the shoulder • No sensory loss in the arm • Wasting of the supraspinatus and infraspinatus muscles Which of the following is the most likely cause of this patient’s symptoms?
A 62-year-old man with a history of hypertension and diabetes presents to the emergency department with sudden-onset double vision and drooping of his right eyelid. On examination, his right eye is deviated “down and out,” and he has ptosis. His right pupil is dilated and nonreactive to light. He also exhibits mild left-sided weakness. His mental status is normal. Which of the following is the most likely cause of his symptoms?
A 28-year-old female is involved in a motorcycle accident and sustains a penetrating injury to her thoracic spine. She is unable to move her right leg and has lost the ability to sense vibration and joint position in the same leg. However, she can still feel pain and temperature sensations on the right side but has lost these sensations on the left side of her body below the injury. Which spinal cord tract is most likely damaged to cause the loss of vibration and joint position sense in the right leg?
A 40-year-old male presents with progressive weakness in his right arm and leg over weeks, alongside numbness to pinprick on his left side below the mid-chest. He denies trauma but reports a history of neck stiffness. Examination shows spasticity and hyperreflexia on the right, absent vibration sense on the right below C6, and loss of pain sensation on the left below C6. MRI reveals a tumor compressing the right side of the spinal cord at C6. What is the most likely cause of this patient’s Brown-Séquard syndrome?
A 35-year-old female is admitted after a motor vehicle accident, sustaining a thoracic spinal cord injury. Neurological examination reveals paralysis of her left leg, loss of touch and vibration sensation on the left side below T8, and reduced pain and temperature sensation on the right side below T8. Imaging confirms a left-sided spinal cord lesion at T8. Which spinal tract is primarily responsible for the loss of pain and temperature sensation on the right side in this patient?
A 40-year-old male is diagnosed with Brown-Séquard syndrome after a stab wound to the left side of his cervical spinal cord. He has left-sided motor weakness and loss of proprioception, with right-sided loss of pain and temperature sensation below the injury. He is hemodynamically stable and has no ongoing bleeding. What is the next best step in management?
A 28-year-old woman reports progressive right-sided weakness and clumsiness over the past two weeks. She also notes a band of numbness and tingling on her left side below the chest. Neurologic exam reveals right-sided hyperreflexia, weakness, and loss of proprioception, with absence of pain and temperature sensation on the left starting at the T8 dermatome. She has no history of trauma. Which of the following is the most appropriate initial diagnostic test?
A 35-year-old male is brought to the emergency department after a stab wound to the right side of his mid-thoracic spine. Neurological examination reveals right-sided weakness below the lesion, loss of proprioception and vibration sensation on the right below the injury, and loss of pain and temperature sensation on the left starting two segments below the lesion. Reflexes are hyperactive on the right, with a positive Babinski sign on the right. Which of the following best explains this patient’s condition?
A patient with known lacunar infarcts is being managed for secondary prevention. He asks about lifestyle modifications that would be most beneficial in reducing his risk of further strokes. Which lifestyle modification is most critical for this patient to prevent further lacunar strokes?
