A 65-year-old woman comes to the physician for the evaluation of sharp, stabbing pain in the lower back for 3 weeks. The pain radiates to the back of her right leg and is worse at night. She reports decreased sensation around her buttocks and inner thighs. During the last several days, she has had trouble urinating. Three years ago, she was diagnosed with breast cancer and was treated with lumpectomy and radiation. Her only medication is anastrozole. Her temperature is 37°C (98.6°F), pulse is 80/min, respirations are 12/min, and blood pressure is 130/70 mm Hg. Neurologic examination shows 4/5 strength in the left lower extremity and 2/5 strength in her right lower extremity. Knee and ankle reflexes are 1+ on the right. The resting anal sphincter tone is normal but the squeeze tone is reduced. Which of the following is the most likely diagnosis?
AAnterior spinal cord syndrome
BCauda equina syndrome
CConus medullaris syndrome
DCentral cord syndrome
EBrown-sequard syndrome
A 54-year-old man is brought to the emergency department 30 minutes after being hit by a car while crossing the street. He had a left-sided tonic-clonic seizure and one episode of vomiting while being transported to the hospital. On arrival, he is not oriented to person, place, or time. Physical examination shows flaccid paralysis of all extremities. A CT scan of the head is shown. This patient's symptoms are most likely the result of a hemorrhage in which of the following structures?
ABetween the dura mater and the arachnoid mater
BInto the cerebral parenchyma
CBetween the skull and the dura mater
DBetween the arachnoid mater and the pia mater
EInto the ventricular system
A 20-year-old man is brought to the emergency department 20 minutes after he sustained a stab wound to his back during an altercation. He reports weakness and numbness of the lower extremities. He has no history of serious illness. On arrival, he is alert and cooperative. His pulse is 90/min, and blood pressure is 100/65 mm Hg. Examination shows a deep 4-cm laceration on his back next to the vertebral column at the level of the T10 vertebra. Neurologic examination shows right-sided motor weakness with diminished vibratory sense ipsilaterally, decreased sensation to light touch at the level of his laceration and below, and left-sided loss of hot, cold, and pin-prick sensation at the level of the umbilicus and below. Deep tendon reflexes of his right lower extremity are 4+ and symmetrical. Babinski sign is absent bilaterally. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?
ABrown-Sequard syndrome
BAnterior cord syndrome
CPosterior cord syndrome
DCauda equina syndrome
ECentral cord syndrome
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