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(A) Digital subtraction angiography (DSA) demonstrated focal stenosis of V2 segment of left vertebral artery (yellow arrow). (B) DSA revealed that the posterior circulation of the brain was otherwise normal beyond the level of stenosis.

Provoked Dizziness from Bow Hunter’s Syndrome

  A 62-year-old man was experiencing debilitating bouts of dizziness provoked by head rotation until ultimately finding relief with cervical spine fixation. He had a history of coronary artery disease, human immunodeficiency virus, tobacco use disorder, and generalized anxiety, and initially presented to a routine primary care visit with 3 weeks of episodic dizziness. During […]

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Chest computed tomography. Bilateral bronchial wall dilatation/thickening was found predominantly in the lower lobe, with scattered nodular patchy airspace opacities and focal areas of mosaic pattern predominantly in the right upper lobe and bilateral tree-in-bud appearance.

Non-Classic Cystic Fibrosis: The Value in Family History

To the Editor: Since the advent of the Human Genome Project, opening doors to an era of genomic medicine, the family history has become a relevant and critical tool in individualized disease prevention. The family history has lasted through the years as a key component of history-taking in medical education. Yet it continues to be […]

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Concussion

Concussion has been recognized as a clinical entity for more than 1000 years. Throughout the 20th century it was studied extensively in boxers,1, 2, 3 but it did not pique the interest of the general population because it is the accepted goal of the boxer to inflict such an injury on their opponent. In 2002, however, the possibility […]

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Brain computed tomography showing bifrontal hypodensity (A; white arrows, precontrast) with focal meningeal enhancement (B; white arrows, postcontrast). Brain magnetic resonance imaging confirmed marked bifrontal edema (C; white arrows, hyperintense on axial T2-weighted image) and leptomeningeal thickening (D; white arrows, axial T1-weighted image with contrast). Salivary gland histopathology showing typical noncaseating granuloma with giant cells (E; black arrows, hematoxylin staining, ×10 magnification).

Leptomeningeal Infiltration, the Hallmark of Neurosarcoidosis

A 22-year-old human immunodefiency virus–negative man was admitted to the intensive care unit for generalized seizures. The patient’s family reported a 1-month history of asthenia and intermittent confusion. Clinical examination revealed isolated inappropriateness of behavior related to a frontal lobe syndrome, without any neck stiffness or neurologic deficit. The patient’s temperature was 37°C. Results from […]

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Hemispheric Cerebral Edema

  A 67-year-old previously healthy man was admitted in November after a seizure. Examination showed normal vital signs, right hemiparesis and facial palsy, global aphasia, and right upper motor neuron signs but no meningeal irritation. Results from chest X-ray, electrocardiogram, and laboratory tests were normal. Neuromaging revealed left hemispheric cerebral edema without evidence of vascular […]

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Conquering ‘Neurophobia’

The evaluation of a patient with neurologic disease remains one of the most daunting and anxiety-provoking tasks in clinical medicine. From the perspective of physicians who are not trained in neurology, the performance and interpretation of the neurologic examination is shrouded in mystery. The angst associated with the study of neuroscience begins in medical school […]

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