3- Clinical Neuroanatomy

Question 1

Pt presents s/p head trauma. Hx reveals he initially “seemed okay” (lucid interval) but has since rapidly deteriorated. What brain injury should you be concerned for and what might you note on CT w/o contrast?

Answer 1

Epidural hematoma affecting middle meningeal artery (fast + dangerous)

CT = lens shape

Question 2

Pt presents w/ hx of non-direct head trauma (ex whiplash). Reports HA, confusion, speech problems, and drowsiness over the next 2-3 weeks following injury. CT w/o contrast reveals a cresent shape. What are you concerned for?

Answer 2

Subdural hematoma affecting bridging veins (slow bleed- venous)

Question 3

Pt presents with sudden onset HA described as “worst HA of life”. On exam pt rapidly deteriorates and becomes comatose. What are you concerned for?

Answer 3

Subarachnoid hemorrhage, aneurysm (fast bleed)

Question 4

Pt presents w/ neural complaint. CT w/o contrast shows “crab of death”. What are you concerned for?

Answer 4

Subarachnoid hemorrhage, aneurysm

Question 5

CT showing effacement of ventricles is commonly due to what?

Answer 5

Mass effect

Question 6

CT showing enlarged temporal horns is indicative of what?

Answer 6

Blocking of ventricles/ buildup of CSF

Question 7

What provides the anterior blood supply to the brain?

Answer 7

Carotids

(R from brachiocephalic/ aorta, L from aorta)

Question 8

What provides the posterior blood supply of the brain?

Answer 8

Vertebral arteries

(join to form basilar arteries, arise from subclavian arteries)

Question 9

What connects both the anterior + posterior AND L + R blood circulations of the brain?

Answer 9

Circle of Willis

(compensatory capabilites)

Question 10

Pt presents with ophthalmoplegia (eye movement paralysis, CN III, IV, VI) or decreased facial sensation (CN V1/V2). You are concerned for a lesion/ pathology in what part of the brain?

Answer 10

Cavernous sinus

Question 11

Pt presents with eye pain and double vision. On PE you note an orbital bruit. Other PE findings may include: proptosis, chemosis, extra-ocular movement paralysis, and decreased facial sensation. What are you concerned for?

Answer 11

Carotid- cavernous fistula

Question 12

How might a deficit in the anterior cerebral artery (ACA) present?

Answer 12

LE manifestation

Question 13

Pt presents with deficits to face/ arm > leg (MCA) OR leg > face/ arm (ACA). You should be concerned for a lesion where?

Answer 13

UMN- cortical lesion

Question 14

Pt presents with equal deficits to face, arm and leg. You should be concerned for a lesion where?

Answer 14

UMN- subcortical lesion

Question 15

The center of the cerebellum is responsible for coordination where?

Answer 15

Head and trunk

Question 16

The lateral portion of the cerebellum is responsible for coordination where?

Answer 16

Extremities

Question 17

CNs II-XII have what type of innervation?

Answer 17

Ipsilateral (same side)

Question 18

What CNs originate from the midbrain?

Answer 18

II, III, IV

Question 19

What CNs originate from the pons?

Answer 19

V, VI, VII

Question 20

What CNs originate from the junction of the pons and medulla?

Answer 20

VIII

Question 21

What CNs originate from the medulla?

Answer 21

IX, X, XI, XII

Question 22

Voluntary motor control has what type of innervation?

Answer 22

Contralateral

Question 23

What are “crossed signs” and where are you concerned for a lesion if noted on PE?

Answer 23

Ipsilateral CN deficits and contralateral body weakness

Lesion in spinal cord

Question 24

Lateral spinothalamic spinal cord tract is responsible for what?

Answer 24

Pain and temp (sensory)

Question 25

Posterior spinal cord tract is responsible for what?

Answer 25

Vibration and **proprioception** (sensory) (ex. (+) Romberg test)

Question 26

Lateral corticospinal spinal cord tract is responsible for what?

Answer 26

Voluntary movement

Question 27

Pt presents with LE pain/ weakness/ paralysis, saddle anesthesia, and B/B dysfunction. You are concerned for a lesion where and what is the management?

Answer 27

Conus medullaris/ cauda equina (spinal cord) Emergencies! - immediate neuroimaging and decompression

Question 28

Pt presents with aphasia, neglect, and hemianopia. Where are you concerned for a brain lesion?

Answer 28

Cortex

Question 29

Pt presents with abnormal movements (chorea, ballism, tremor, cogwheeling). Where are you concerned for a brain lesion?

Answer 29

Subcortical structures (internal capsule, basal ganglia)

Question 30

Pt presents with truncal vs limb ataxia and dysmetria (ex. unable to move finger to nose). Where are you concerned for a brain lesion?

Answer 30

Cerebellum

Question 31

Pt presents with muscle fasciculations with NO sensory involvement. Where are you concerned for a lesion?

Answer 31

LMN

Question 32

Pt presents with distal weakness and sensory involvement, stocking-glove presentation, areflexia, or hyporeflexia. Where are you concerned for a lesion?

Answer 32

Peripheral nerve

Question 33

Pt presents with fatiguability, no sensory involvement, and normal DTRs. Where are you concerned for a lesion?

Answer 33

NMJ

Question 34

Pt presents with proximal weakness that is symmetric and NO sensory involvement. What are you concerned for?

Answer 34

Muscle

Question 35

Pt presents with monocular blindness. Where are you concerned for a lesion?

Answer 35

Ipsilateral optic nerve

Question 36

Pt presents with bitemporal hemianopia. Where are you concerned for a lesion?

Answer 36

Optic chiasm

Question 37

Pt presents with homonymous hemianopia. Where are you concerned for a lesion?

Answer 37

Contralteral optic tract

Question 38

Pt presents with homonymous quadrantanopia. Where are you concerned for a lesion?

Answer 38

Contralateral parietal lobe

Question 39

Pt presents with macular sparing. Where are you concerned for a lesion?

Answer 39

Contralateral occipital lobe

Question 40

Pt presents with inability to fully close 1 eyelid. Where are you concerned for a lesion?

Answer 40

CN VII

Question 41

Pupillary reflex involves which 2 CNs?

Answer 41

II, III

Question 42

Corneal reflex involves which 2 CNs?

Answer 42

V1, VII

Question 43

Vestibulo-ocular reflex involves which 2 CNs?

Answer 43

VIII, V1/3

Question 44

Gag reflex involves which 2 CNs?

Answer 44

IX, X

Question 45

If pt has a lesion to CN XII, what direction will the tongue deviate towards?

Answer 45

Towards the side of the lesion ("lick your lesion")

Question 46

Spasticity is what type of movement? Spasticity, hyper-reflexia, and (+) Babinski indicate a lesion where?

Answer 46

Velocity dependent (more tone w/ faster movement) UMN lesion

Question 47

Rigidity (Cogwheel rigidity) is what type of lesion and where does it indicate a lesion?

Answer 47

Velocity independent (same tone regardless of speed) Basal ganglia lesion

Question 48

Biceps, brachioradialis, and triceps DTRs involve what main spinal nerve roots?

Answer 48

Biceps- C5, C6 Brachioradialis- C6 Triceps- C7

Question 49

Patellar and achilles tendon DTRs involve what main spinal nerve roots?

Answer 49

Patellar- L4 Achilles tendon- S1

Question 50

Flaccid weakness, hypo-reflexia, atrophy and fasciculations indicate a weakness/ lesion where?

Answer 50

LMN

Question 51

Loss of reflexes, sensation, and coordination in a stocking glove pattern is known as what?

Answer 51

Length-dependent peripheral neuropathy (at the terminals of the longest nerves, a/w DM)

Question 52

Aphasia, apraxia, and agnosia are a/w a lesion where?

Answer 52

Cortical