A 14-year-old female presents with a first episode of acute-onset right-sided weakness and numbness below her chest. Spinal MRI shows a T2 hyperintense lesion at the T4 level that involves only the left half of the spinal cord and is limited to two vertebral segments. Brain MRI is normal. This hemicord pattern of myelitis should raise the highest suspicion for which underlying condition?
A 1-month-old neonate presents with encephalopathy and focal seizures. A brain MRI is performed. Her mother had a complicated delivery. You are considering a diagnosis of cerebral sinovenous thrombosis (CSVT). Which clinical feature is more characteristic of CSVT in children compared to arterial ischemic stroke (AIS)?
A premature infant, born at 29 weeks gestation, suffers a significant intraventricular hemorrhage that extends into the subarachnoid space. Over the next few weeks, the infant develops progressive hydrocephalus. The obstruction to cerebrospinal fluid (CSF) flow is determined to be at the level of the basal cisterns and arachnoid villi, secondary to inflammation and fibrosis from the blood products. How is this type of hydrocephalus best classified?
An 8-year-old previously healthy boy develops sudden onset of left-sided weakness. One month prior, he had a documented case of chickenpox. A brain MRI confirms an acute infarction in the right basal ganglia, and MR angiography shows irregular stenosis of the proximal right middle cerebral artery. What is the most likely diagnosis for his arteriopathy?
A 15-year-old girl presents with a 6-month history of suboccipital headaches that are notably worse with coughing, sneezing, and straining. She also reports intermittent tinnitus and a sense of imbalance, but no hydrocephalus is noted on imaging. A brain magnetic resonance imaging scan is ordered. These symptoms are most suggestive of which condition?
A 24-year-old pregnant woman undergoes a routine second-trimester ultrasound, which reveals anencephaly in the fetus. When discussing the findings with the family, the physician mentions other common associated findings. Which additional finding is most likely to be present on the ultrasound in a pregnancy affected by anencephaly?
A 7-year-old girl with newly diagnosed childhood absence epilepsy has experienced multiple staring spells daily, confirmed on EEG with 3-Hz spike-and-wave discharges. Her parents are concerned about medication side effects. Which of the following is the most appropriate initial monotherapy, balancing efficacy and toxicity?
A 16-month-old presents with intermittent episodes of hemiplegia that alternate sides, sometimes lasting for days before resolving spontaneously during sleep. During episodes, choreoathetotic and dystonic movements are seen in the affected limb. Neuroimaging has excluded moyamoya disease. Which diagnosis is most consistent with this presentation?
A 6-year-old boy has a continuous generalized tonic-clonic seizure for 15 minutes. IV access is not yet available. Paramedics arrive at the scene. After stabilizing the patient’s airway, what is the most appropriate initial evidence-based intervention?
A 10-year-old with a history of cyanotic congenital heart disease presents with a week of worsening headache, low-grade fever, and a new-onset focal seizure. An MRI with contrast reveals a 3 cm ring-enhancing lesion in the parietal lobe. Which group of organisms is most commonly associated with this predisposing condition?
