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Infections

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The most striking neurological complication of von Economo encephalitis (encephalitis lethargica), a type of encephalitis that occurred in epidemic proportions along with viral influenza between 1917 and 1928, was which of the following?

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a. Blindness

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b. Hearing loss

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c. Paraplegia

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d. Parkinsonism

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e. Incontinence

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The answer is d. At the onset of encephalitis lethargica, patients often develop transient fevers, lethargy, and headache. Disturbed eye movements are the most common sign of neurological disease during the acute illness. A variety of movement disorders, including chorea, athetosis, dystonia, and myoclonus, develop with the disease. About one in four affected persons die. The most common sequela of the disease is severe, unremitting parkinsonism with signs and symptoms similar to those exhibited with idiopathic parkinsonism. One rather unique feature is the occurrence of oculogyric crises, or episodes in which the eyes deviate to one side or upward, associated with other forms of dystonia and autonomic symptoms, sometimes occurring with great regularity.

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A 37-year-old woman is noted to have lymphadenopathy on routine physical examination. Following an extensive evaluation, she is diagnosed with sarcoid. She has been entirely normal neurologically. Which cranial nerve (CN) is most likely to be injured in this patient?

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a. II

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b. III

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c. V

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d. VII

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e. VIII

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The answer is d. Facial paresis is the neurological injury most likely to develop with sarcoidosis. Almost half of patients with sarcoidosis and neurological disease have a neurological sign or symptom as the first obvious complication of the sarcoidosis. These patients report progressive weakness of one side of the face with no substantial loss of sensation over the paretic side. They may feel that there is decreased sensitivity to touch on the weak side, but this is more commonly from a loss of tone in the facial muscles than from an injury to the trigeminal nerve. Other CNs especially susceptible to injury in persons with sarcoidosis include II, III, IV, VI, and VIII.

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A 17-year-old girl presents initially with fever and progressive weakness. An extensive neurological evaluation including electromyography (EMG)/nerve conduction studies (NCS) suggests a motor neuron disease. The motor neuron disease most certainly traced to a virus is which of the following?

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a. Poliomyelitis

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b. Subacute sclerosing panencephalitis (SSPE)

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c. Progressive multifocal leukoencephalopathy ...

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