Mitral Valve Prolapse and Mitral Regurgitation. Review of mitral valve anatomy and function, including papillary muscle structure and function, with severe mitral valve prolapse and mitral regurgitation due to a flail segment caused by ruptured papillary muscle and chorda tendinae attachment.

Progressive multifocalleukoencephalopathy is a demyelinating illness of the central nervous system that typically occurs in immunosuppressed patients, especially those with AIDS. It is caused by reactivation of the polyomavirus JC (JC virus) and presents with neurologic deficits including hemiparesis, gait ataxia, visual symptoms, and altered mental status. It is not seen in non-immunosuppressed patients, and fever is not typical

Herpes simplex encephalitis is characterized by acute-onset (<1 week) fever, headaches, seizures, altered mental status, and focal neurologic findings such as hemiparesis or cranial nerve deficits. This patient's weakness/fatigue for >1 week, heart murmur, history of drug abuse, and absence of focal neurologic deficits make endocarditis with mycotic aneurysm more likely than herpes encephalitis

The headache, lethargy, and neck stiffness suggest subarachnoid hemorrhage secondary to rupture of a mycotic aneurysm. Mycotic or infected arterial aneurysms can develop due to metastatic infection from IE, with septic embolization and localized vessel wall destruction in the cerebral (or systemic) circulation. Intracerebral mycotic aneurysms can present as an expanding mass with focal neurologic findings or may not be apparent until aneurysm rupture with stroke or subarachnoid hemorrhage. The diagnosis of mycotic cerebral aneurysm can usually be confirmed with computed tomography angiography. Management includes broad-spectrum antibiotics (tailored to blood culture results) and surgical intervention (open or endovascular).

patient has fever, hypotension, swelling, and erythema of his left leg. Notably, his leg is more painful to palpation than might be expected after visual inspection. These symptoms are very concerning for necrotizing fasciitis. Necrotizing fasciitis is a fulminant infection of the subcutaneous tissue that spreads rapidly along the fascial planes and leads to extensive tissue necrosis and shock. Treatment • Requires surgical debridement & broad-spectrum antibiotics

Two types of clinically distinct necrotizing fasciitis have been described. The most common form (type II) usually occurs in individuals with no concurrent medical illness. Many patients report a history of laceration, blunt trauma, or a surgical procedure as a predisposing factor. It is typically caused by group A Streptococcus (Streptococcus pyogenes). In contrast, type I is usually seen in patients with underlying diabetes and peripheral vascular disease. It is generally a polymicrobial infection; some commonly isolated organisms include Staphylococcus aureus, Bacteroides tragi/is, Escherichia coli, group A Streptococcus, and Pre vote/fa species. Crepitus is more common if anaerobic organisms, such as Clostridium perfringens or 8 tragi/is, are involved.

CD4 T-cells (a type of white blood cell) are important to your body's defence against infections. This animation describes how your immune system is weakened by the HIV virus, which targets CD4 T-cells and leads to their gradual decline in number. Low to very low levels of CD4 cells put you at risk for 'opportunistic infections' that take advantage of the body's weakened immune system.

In developing countries, domestic animals (eg, dogs) are common sources of infection. In the United States, bats and wild animals (eg, raccoons) are the most common reservoirs of infection. The acquisition of rabies from bats can occur from an unrecognized bite or a scratch, and possibly by inhalation of aerosolized viral particles. Bats are found in all states except Hawaii, and spelunking (cave exploration) is a risk factor for rabies acquisition from bats.

If you suspect that you have sleep apnea, the usual first step is to discuss your suspicions with your primary care physician. If you don’t have a primary care physician, you can go directly to a clinician who is a sleep specialist. But check your health care insurance coverage first. Some policies require you to see a primary care physician first, and some policies limit the sleep centers and testing facilities whose services they will pay for. Unfortunately, you may discover that your policy offers limited or no coverage for the diagnosis and treatment of sleep apnea, in which case you may wish to switch insurers if and when you can.

Narcolepsy is a chronic sleep disorder characterized by overwhelming daytime drowsiness and sudden attacks of sleep. People with narcolepsy often find it difficult to stay awake for long periods of time, regardless of the circumstances. Narcolepsy can cause serious disruptions in your daily routine. Sometimes, narcolepsy can be accompanied by a sudden loss of muscle tone (cataplexy) that leads to weakness and loss of muscle control. Cataplexy is often triggered by a strong emotion, most commonly laughter. Narcolepsy is a chronic condition for which there's no cure. However, medications and lifestyle changes can help you manage the symptoms. Support from others — family, friends, employer, teachers — can help you cope with narcolepsy.

Migraine headaches are recurrent throbbing or pulsatile headaches often associated with a prodrome, nausea, vomiting, photophobia, and phonophobia. When they occur, the prodromes are characterized by visual scintillations, scotomas, dizziness, or tinnitus

Holter monitoring, electrocardiogram or echocardiogram are only recommended if a cardiac cause (e.g., arrhythmias, possible cardiac syncope, myocardial ischemia) is suspected.

The "Get up and go" test is most commonly used to assess postural stability. In this test, the physician instructs the patient to stand up from a chair without assistance, walk a short distance, turn around, return, and sit down again. If the patient is unsteady or has difficulties during the test, further evaluation is necessary.

Vertebrobasilar insufficiency is typically secondary to emboli, thrombi, or arterial dissection. The labyrinth and brainstem are commonly affected, and symptoms may include vertigo, dizziness, dysarthria, diplopia, and numbness.

Cataplexy is a sudden, temporary loss of muscle tone that can result in collapse. It is often caused by intense emotions, including laughter

Panic attacks are discrete periods of intense fear or discomfort. Symptoms may include palpitations, sweating, trembling, shortness of breath, a choking sensation, chest pain, nausea, dizziness, paresthesias, and a fear of dying or losing control

demonstrates how the Epley maneuver is performed to treat POSTERIOR canal BPPV affecting the right ear. Animation showing what is going on within the inner ear is also shown in the 2nd half of the video.

Benign paroxysmal positional vertigo is an abnormal feeling of motion triggered by certain provocative positions. The condition is most often attributed to the presence of calcium debris within the posterior semicircular canal. Nystagmus is commonly seen

Labyrinthitis is a mild, often self-limited condition characterized by vertigo, tinnitus, nausea, and a loss of balance. The disorder often follows a viral illness (eg, influenza). Labyrinthitis may also be caused by trauma, bacterial infection, allergies, benign tumors, and certain medications .

Binswanger's disease is a type of vascular dementia that involves white matter infarcts. Patients with this disease usually present with apathy, agitation, and bilateral corticospinal or bulbar signs