Brain lesions Flashcards
Visual problem in pituitary tumor compressing optic chiasm?
Bitemporal hemianopsia
Unsteady gait, appendicular ataxia in LE only and normal eye movement. Walks with ruching broad based gait
Cerebellar degeneration (alcoholic)
Severe occipital HA, BL papilledema. Chronic acne treated with isotretinoin. LP with elevated OP with no cells, glucose=62, protein=22. CT normal.
Psudotumor cerebri.
66 y/o with frequent falls, several month hx of anxiety, unwillingness to leave home. On exam, mild impairment of vertical gaze on smooth pursuit/ saccades, mild axial rigidity, and minimal rigidity of upper extremities, along with mild slowness of movement on finger tapping, hand opening, and wrist opposition. Posture nml. Gait tentative/ awkward, but w/o shuffling, ataxia, tremor. Pt is slow in arising from chair. Dx?
Progressive supra nuclear palsy.
79 y/o pt with deteriorating mental state over a 3 week period has an exaggerated startled response with violent myoclonus that is elicited by turning on the room lights, speaking loudly, or touching the pt. Myoclonic jerks are also seen. Dx
Spongiform encephalopathy
Pt presents with a slowly progressive gait disorder, followed by impairment of mental function, and sphincteric incontinence. No papilledema or headaches are reported. Likely dx?
Normal pressure hydrocephalus
65 yo pt fell several times past 6months. MSE nml. Smooth pursuit, saccadic movements impaired. Worse with vertical gaze. Full ROM with doll head maneuver. Mild symmetric rigidity/ bradykinesia, no tremor. MRI/CSF/labs unremarkable. Dx?
Progressive supra nuclear palsy.
28 y/o with emotional lability and impulsivity. LFTs elevated. Close relative had similar sx and died at 30 y/o from hepatic failure. Which blood levels would be dx?
Cerulopasmin.
Pt with acute onset of pain and decreased vision in the R eye. Colors look faded when viewed through the R eye. On exam, has a R afferent pupillary defect and a swollen right optic disc. Pt spontaneously recovers over the next 6 weeks. Likely to develop later?
MS
9 y/o F has 3 mo h/o seemingly unprovoked bouts of laughter. Worse when not sleeping well.Pt doesn’t feel happy during these episodes. Started menstruating 6 mo ago, at Tanner stage 4.Dx?
Hypothalamic hamartoma
5 y/o with 4 month story of morning hA, vomiting, and recent problems with gait, falls, and diplopia.
Medulloblastoma
70 y.o develops flaccid paralysis following severe water intoxication. He develops dysphagia and dysarthria without other CN involvement. Sensory exam is limited but grossly normal. DTRs are symmetric, and cognition is intact. Lively dx?
Central pontine myelin-lysis
Young adult gained 70 lbs in last year c/o daily severe headaches sometimes ass. with graying out of vision. Papilledema present. CT and MRI brain no abnormalities but ventricles smaller than usual. Goal of tx in this case?
Prevent blindness.
Superior homonymous quadratic defects in the visual fields result from lesions to which of the following structures?
Temporal optic radiations.
Tremor with frequency of around 3Hz, irregular amplitude, most evident towards end of reaching movements
Cerebellar tumor
Pt with several days of fever and severe HA, presents to ED b/o generalized seizure. Pt is confused and somnolent. Also reported to have been irritable and c/o foul smell. T2 MRQ displayed hyper intensity of left temporal.
Herpes encephalitis.
Acute onset of fever, sore throat, diplopia and dysarthria. Exam reveals an inflamed throat, left adductor nerve palsy w/ impairment of vertical pursuit diffuse hyperreflexia w/ bilateral clonus, lower ext spasticity, and mild R hemiparesis. Ct normal. CSF protein =24, mononuclear cells= 10, glucose= 70. Dx?
MS
Which is the most reliable finding from CSF analysis for a pt with MS in the chronic progressive phase of the disease?
Presence of oligoclonal bands
Benign intracranial HTN etiology
Hypervitaminosis A
Gait abnormality, slow movement, asymmetric UE rigidity. Difficulty in voluntary vertical upward/ downward gaze. Slowness/ rigidity improved slightly with levodopa. Later has problems with horizontal and vertical gaze. Oculocephalic reflexes normal. Involuntary saccades.
Progressive supra nuclear palsy.
Pt presents with personality changes, cognitive difficulties, affective lability, and olfactory and gustatory hallucinations. most likely medical cause?
HSV infection
What condition is a forerunner of MS?
Trasverse myelitis
Location of characteristic lesion seen in CT scans of pt with carbon monoxide poisoning associated comas?
Globus pallidus
Hx of dementia and myoclonus shows what pathologic changes in cresol violet changes
Cytosolic vacuolation of neuroglia with prion inclusions
What is the presentation expected with Wernicke’s encephalopathy?
Amnesia, confabulation, lack of insight
AIDS pt with new onset headache and cognitive decline, MRI shows multiple ring enhancing lesions. Cause?
Toxoplasmosis gondii
Neuropsychological test that examines both visual/spacial and executive functions?
Clock drawing
Imagine of a clock, with all the numbers drawn only on the R hand side, where is the lesion?
Parietal lobe
Head injury with personality changes, impulsivity, and euphoria. Site of injury?
Orbitofrontal cortex
What is the transmissible element that causes progressive decline and myoclonic jerks. Brain biopsy shows spongiform changes?
Prion
Kluver-Bucy syndrome: plasticity hyperorality, hyper sexuality, and hyperphagia, can be induced in animals with bilateral resection of which structure?
Temporal lobes
Most common psych complication from TBI
Depression
Executive dysfunction comes from damage to
Fronto-subcortical
36 y/o pt with double vision, vertigo, paresis of medial rectus on lateral gaze w coarse nystagmus in abducting eye w/lateral eye movement
MS
35 y/o pt w/ new onset headache, what suggests mass lesion with raised ICP?
Papilledema on eye exam
Aphasia secondary to lesion in posterior third of left superior temporal gyrus
Wernicke
57 y/o has new onset speech difficulty cannot name objects and sometimes cannot say “yes or no” and cannot repeat “no ifs, ands, or buts” but can follow verbal and written commands. No problems with chewing/ swallowing. What is the condition?
Broca’s aphasia
5 y/o presents with sudden onset of slurred speech and gait difficulty. Exam shows truncal ataxia and nystagmus, mild dysarthria and extensor plantar responses. Recent h/o measles. MRIA, UA, blood unremarkable. Dx?
Acute cerebellitis
Abulia refers to impairment in ability to
Spontaneously move and speak (inability to act decisively, absence of willpower)
Prosopagnosia is
Inability to recognize faces
56 y/o m with normal brain scan and no prior psych history is impulsive and dishinbited with personality changes. What would a PET scan likely show?
Bilateral temporal lobes with reduced perfusion
Inability to recognize objects by touch
Astereognosis
Which cancer has the highest likelihood of going to the brain?
Lung
Etiology of meningitis ass. with fever, HA, CSF pleocytosis with lymphocyte predominance, slightly elevated CSF protein, and normal CSF glucose
Coxackie virus
MC solid tumor of the CNS in kids
Neuroblastoma
75 y/o patient evaluated for progressive gait, urine incontinence, and cognitive decline. After removal of CSF, there is improvement in gait and balance. What would CT show?
Enlargement of the frontal horns.
41 y/o with chronic fatigue, cognitive impairment, reduced perceptual motor speed, poor effort maintenance, and irritability. MRI shows hyperintensity in frontal lobe and what looks like a finger protrusion
MS
25 y/o pt c/o severe HA and vomiting. Pain is dull and mostly in the occipital region. Exam; b/l severe papilledema, otherwise WNL. LP: OP: 200, no cells, glucose 62, protein 31. CT normal. Dx
Pseudotumor cerebri.
Histology consistent with Jakob- Creutzfeldt disease
Cytosolic vacuolation of neurons and flea with prion inclusions
Dx for 68 y/o c/o falls. PE shows upright rigid posture, stiff gait, extended knees, and pivoting while turning
Progressive supra nuclear palsy
Dx of a 32 y/o woman w/ vertigo and INO
MS
70 y/o pt develops confusion, lethargy, and generalized tonic-clonic seizure. Lab reveals Na= 95. This is most likely a complication of excessively rapid correction of which metabolic problem?
Central Pontine myelin-lysis
Hippocampal atrophy has been identified in all of the following disorders
MDD, ALZ, PTSD
Severe occipital HA, BL papilledema, and vomiting. Just started birth control pills. LP with elevated OP. CT normal
Sagittal sinus thrombosis
Condition is most likely to account for the presence of cognitive impairment in a pt with untreated Hep C infection and normal ammonia level who is HIV serotonin-negative
HCV infection of brain
Delayed neurological deterioration following carbon monoxide induced coma is mot likely manifested by
Parkinsonism
Causative agent of progressive multifocal leukoencephalopathy
JC virus
68 y/o pt is depressed following a hip surgery. Pt is withdrawn, looks blank, shows dysarthria, weakness, PMR, hyperreflexia, and has trouble swallowing. MRI of the head will show
Periventricular white matter demyelination
Adult LP with OP= 190, protein= 110, glucose= 27, leukocytes 5,000. Dx?
Bacterial meningitis.
75 y/o M, korean war veteran, with gradual development of forgetfulness and cognitive deterioration, presents with very fast slurred speech and impaired gait. A head CT shows some generalized atrophy, unusual for his age. The LP shows 35 WBCm lymphocytosis, and the protein is 110.. Elevated gamma globulin. Dx?
Neurosyphilis.
Inability to carry out motor activities on verbal command despite intact comprehension and motor function indicates?
Apraxia
80 y/o pt is unable to blow out match although motor and sensory function are normal. What is it called?
Apraxia
MCC of aseptic meningitis
Enteric virus
25 y/o m with 7 months depression, forgetfulness, weight loss, insomnia, painful tingling in both feet + incoordination. Involuntary choleric movements of B/L UE, apathetic, monosyllabic. Labs normal. EEG: mild diffuse slowing. CT/MRI nil. During admission develops severe akinetic mutism, seizures, and dies. Brain autopsy shows
Diffuse amyloid plaques, spongiform neuronal degeneration, and severe astrogliosis.
52 y/o pt with OH dependence present with several days of severe HA, nausea, and low grade fever. PE reveals mild disorientation, nuchal rigidity, and mild spasticity in the lower extremities. Head CT normal. LP= 55, 3 leukocytes, glucose 45, protein 43, and gram + spherical cells. Most likely causative organism
Cryptococcus neoformans
CT and MRI show ventriculomegaly out of proportion to sulfa atrophy. This is suggestive of?
Normal pressure hydrocephalus
49 y/o male patient with OH dependence is brought to ED with one week hx of malaise, HA, diplopia, lethargy, and confusion. On exam, T= 38.2, stiff neck, deviation of R eye with impaired abduction and hoarseness. CSF: 114, predominantly monocytes, protein 132, glucose 29. Likely type of meningitis
Tuberculosis
Closed TBI, initially no LOC, then 20 min later LOC. Patient recovers in 5 minutes
Vasovagal syncopal attack
15 y/o pt fell to the ground after being hit in the head while playing soccer. Pt did not lose consciousness, but was confused for the following 20 min. The next day, pt reported a HA and irritable, neuron exam normal. Best recommendation?
Should be examined in 2 weeks before resuming play
In ER following MVA, received IV dextrose 5%. Experiences confusion, oculomotor paralysis, and dysarthria
Wernicke’s encephalopathy
Which of the following is invariably the first manifestation of neurosyphilis?
Meningitis
14 y/o @ summer camp develops severe HA and fever, drowsiness, stiffness of neck on passive forward flexion, petechial rash and skin pallor. Spinal tap reveals OP= 200, 84% neutrophils (7k nucleated cells), glucose= 128, and protein=33. Most likely causative agent?
Meningococcus
Which hormone is secreted in functional pituitary adenoma
Prolactin
Primary characteristic of Warnicke encephalopathy
Acute onset
52 y/o M presents with a CC of gait difficulties. On exam: mild dysarthria, very mild finger to nose ataxia and minimal heel to shin ataxia. Romberg test negative, but very unsteady while walking and walks with a broad based, lurching gait. The plantar reflexes are flexor. imaging studies are most likely to demonstrate
Cerebellar vermis atrophy
75 y/o veteran with gradual onset forgetfulness, intellectual deterioration, fast/slurred speech, gait impaired, CT with normal atrophy. LP shows 35 WBC (mostly lymphocytes), protein 110, increased gamma globulin. Dx?
Neurosyphilis
41 y/o female patient without Fhx of corticocerebellar degeneration presents with 3mo hx of ataxia of gait and limbs, dysarthria, and progressive nystagmus. MRI and CSF normal. 1. Ab panel with presence of? 2. What type of tumor most likely?
- Anti-Yo
2. Ovarian carcinoma
MRI finding for a woman with memory decline, urinary incontinence, and trouble walking
Dilation of ventricles
Effortful, non-fluent speech with decreased speech output, where is the lesion?
Anterior frontal gyrus
A 50 yo BIB ED for SA by being in a closed garage with the cars running for several hours. CT brain 2 weeks later will show
lesion in globus pallidus
Which of the following tests is recommended by the American Academy of Neurology to establish dx of brain death
Apnea test
Essential criterion for declaration of brain death prior to organ donation requires?
A positive apnea test
43 y/o newly AIDS patient has increasing social withdrawal and irritability over several weeks. Can’t remember phone number, unable to do chores, appears distracted. Mild R hemiparesis, L limb ataxia, and bilateral visual field defects. LP normal. CT T2 scan shown. Dx?
Progressive multifocal leukoencephalitis.
Risk factor for depression in MS pts
Lesion volume
Right handed pt recently underwent neurosurgery is now unable to name objects in L hand when blind folded. He was able to name them when displayed on screen. Dx?
Corpus callosum
Bilateral paresis of medial rectus muscle during lateral gaze with course nystagmus in abducting eye characteristic of
MS
82 y/o with progressive dementia, myoclonus over 3 months. EEG shows periodic sharp waves with 1Hz over both hemispheres. Dx?
Creutzfeldt- jakob disease
Elderly man with blurry vision. Eyes slow away, rapid corrections lateral gaze. Do not occur during fixation on target. What is dysfunction?
Vestibular labyrinth
Neuro exam of 59 yo testing slap palm of hand on knee alternating with dorsum hand rapidly. Difficulty with maneuver, clumsy, irregular. Which describes this personality?
Dysdiadochokinesia
Describe gait in elderly male with memory impairment and gait disturbance that improves after large volume LP
Magnetic
