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Cerebrovascular Disease 01

Topic: Adult

Created on Monday, April 9 2007 by jdmiles

Last modified on Monday, April 9 2007.

A formerly healthy 77 year-old male presents with a 2-week history of worsening dyspnea and weakness. Exam reveals numerous ulcerating lesions in the nares and oral mucosa. There is a left facial palsy and a right abducens palsy. There is weakness in knee flexion, knee extension, plantarflexion, and dorsiflexion on the left. Bloodwork reveals a high c-ANCA titer. Which of the following diagnoses is most likely?

 
        A) Polyarteritis nodosa
 
        B) Behcet disease
 
        C) Conversion disorder
 
        D) Takayasu disease
 
        E) Wegener granulomatosis
 

 


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This question was created on April 09, 2007 by jdmiles.
This question was last modified on April 09, 2007.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANSWERS AND EXPLANATIONS




A) polyarteritis nodosa

This answer is incorrect.


The mononeuropathy multiplex described here is an uncommon presentation for polyarteritis nodosa. Additionally, the elevated c-ANCA is not characteristic of polyarteritis nodosa.  (See References)

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B) Behcet disease

This answer is incorrect.


The oral lesions and polyneurtis this patient presents with are consistent with Behcet disease. However, the elevated c-ANCA makes Wegener granulomatosis a better choice.  (See References)

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C) conversion disorder

This answer is incorrect.


Conversion disorder is not a likely explanation for this patient's symptoms, physical findings, or lab results  (See References)

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D) Takayasu disease

This answer is incorrect.


Takayasu disease is an arteritis that typically involves the aorta and the large arteries arising from it. The presentation described above is not consistent with Takayasu disease, nor is the elevated c-ANCA.  (See References)

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E) Wegener granulomatosis

This answer is correct.


This patient presents with a subacute, evolving mononeuropathy and a high c-ANCA titer. This is a typical presentation for Wegener granulomatosis.  (See References)

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References:

1. Victor, M., and Ropper, A.H. (2001). Adams and Victor's Principles of Neurology, 7th Edition. McGraw-Hill, New York.
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adult
Cerebrovascular Disease 01
Question ID: 040907169
Question written by J. Douglas Miles, (C) 2006-2009, all rights reserved.
Created: 04/09/2007
Modified: 04/09/2007
Estimated Permutations: 600

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