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Một người đàn ông 22 tuổi với đau đầu và các vấn đề bằng cách sử dụng máy tính của mình. Các ngày trước đó tại nơi làm việc, ông này khởi phát đột ngột của vụng về trong tay phải của ông và không thể sử dụng máy tính của mình bằng cả hai tay. Điều này được đi kèm bởi một cơn đau đầu nhẹ | CLINICAL STROKE QUESTIONS 87 232. A 22-year-old man presented with headache and problems using his computer. The previous day at work he had sudden onset of clumsiness in his right hand and was unable to use his computer with both hands. This was accompanied by a mild headache. Several weeks earlier he had had an erythematous rash that he attributed to allergies. He had hyperreflexia and slowing of fine motor coordination in the right upper extremity. Pupils were 3 mm and reactive. Spinal fluid analysis revealed a protein of 84 and 24 white blood cells all mononuclear. He had acute multiple infarcts on MRI and cerebral angiography revealed multifocal narrowing consistent with vasculitis. His VDRL screen was negative. The most likely cause of the patient s signs and symptoms is A. Primary angiitis of the CNS. B. Lyme disease. C. Paradoxical emboli from a patent foramen ovale PFO . D. Herpes encephalitis. 233. A 24-year-old HIV-positive man presented to the emergency department with right arm weakness and incoordination. He had been well until the past 3 weeks when he developed headaches fevers and fatigue. On neurologic examination he had hyperreflexia in the right arm with mild weakness and ataxia of that limb. He was somnolent falling asleep when not stimulated. His temperature was 38.5 C and his blood pressure was normal. In the emergency room he had a generalized seizure. An MRI scan showed an acute infarct in the left basal ganglia along with mild hydrocephalus and enhancement of the basal leptomen-inges. There was cerebrospinal fluid CSF pleocytosis with 78 white cells all mononuclear a protein of 110 and a glucose of 36. Acid-fast bacillus AFB staining was negative and no bacteria were seen on staining of the spinal fluid. This picture is most consistent with A. Tuberculous meningitis. B. Bacterial meningitis. C. Systemic lupus erythematosus. D. Cerebral vasculitis. E. Infective endocarditis. 234. Which statement about cerebral malaria is true A. Steroids are
