NMS Q&A Family Medicine

78 NMS Q&A Family Medicinethe diagnosis of cancer. Therefore, occult malignancymust be considered initially in the differential diagnosisof Guillain–Barré syndrome as well. Mononeuropathiesinvolve just one peripheral nerve, for example, cranialnerve VI palsy occurring in diabetes, usually type I.15. The answer is B. This history fits that of chronic subduralhematoma from acceleration–deceleration forcesthat cause tearing of bridging veins in a closed head injury.Such injuries are more likely to occur in older people andoften without a definite history of head injury. Whetherthey should be evacuated surgically depends on the clinicalsituation and the thickness of the hematoma. Postconcussionsyndrome presents similarly clinically but wouldhardly be expected to be devoid of a clear history of headtrauma, complete with a healing scalp contusion. Subarachnoidhemorrhage is arterial and as such is suddenand dramatic (see chapter 7). Strokes virtually alwaysresult in focal and lateralizing neurological findings; also,their onsets are rapid, not subtle.ReferencesAminoff MJ . Nervous system . In: Tierney LM , McPhee SJ ,Papadakis MA , eds. Current Medial Diagnosis and Treatment, 43rd ed . New York : McGraw-Hill/Appleton & Lange ;2004 : 941 – 1000 .Calabresi PA . Diagnosis and management of multiple sclerosis .Am Fam Physician . 2004 ; 70 : 1935 – 1944 .Family Medicine Board Review 2009 . Kansas City, May 3–9.Rowland LP , ed. Textbook of Neurology . Baltimore, MD : Williams& Wilkins ; 1995 .Smaga S . Tremor . Am Fam Physician . 2003 ; 68 : 1545 – 1552 .Verrees M , Selman WR . Management of normal pressure hydrocephalus. Am Fam Physician . 2004 ; 70 : 1071 – 1078 , 1085 –1086 .