Brain Lesions

Question 1

Parietal lobe lesions

Answer 1

sensory inattention
apraxias
astereognosis (tactile agnosia)
inferior homonymous quadrantanopia
Gerstmann’s syndrome (lesion of dominant parietal): alexia, acalculia, finger agnosia and right-left disorientation

Question 2

Occipital lobe lesions

Answer 2

homonymous hemianopia (with macula sparing)
cortical blindness
visual agnosia

Question 3

Temporal lobe lesions

Answer 3

Wernicke’s aphasia: this area ‘forms’ the speech before ‘sending it’ to Brocas area. Lesions result in word substituion, neologisms but speech remains fluent
superior homonymous quadrantanopia
auditory agnosia
prosopagnosia (difficulty recognising faces)

Question 4

Frontal lobe lesions

Answer 4

expressive (Broca’s) aphasia: located on the posterior aspect of the frontal lobe, in the inferior frontal gyrus. Speech is non-fluent, laboured, and halting
disinhibition
perseveration
anosmia
inability to generate a list

Question 5

Cerebellum lesions midline lesions: gait and truncal ataxia
hemisphere lesions: intention tremor, past pointing, dysdiadokinesis, nystagmus

Question 6

Medial thalamus and mammillary bodies of the hypothalamus

Answer 6

Wernicke and Korsakoff syndrome

Question 7

Subthalamic nucleus of the basal ganglia

Answer 7

Hemiballism

Question 8

Striatum (caudate nucleus) of the basal ganglia

Answer 8

Huntington chorea

Question 9

Substantia nigra of the basal ganglia

Answer 9

Parkinson’s disease

Question 10

Amygdala

Answer 10

Kluver-Bucy syndrome (hypersexuality, hyperorality, hyperphagia, visual agnosia

Question 11

Lesions of the vagus nerve (CN X) may result in:

Answer 11

Uvula deviates away from the site of the lesion
Loss of gag reflex (efferent)

Question 12

Brown sequard syndrome

Answer 12

Spinal cord hemisection (damage limited to one half), leading to paralysis on side of lesion and loss of sensation on opposite side.
• corticospinal tract damage- loss of upper motor neuron innervation leading to ipsilateral spastic paralysis below level of lesion due to damage to lateral corticospinal tract. Damage to lower motor neuron at level of spinal injury leading to ipsilateral flaccid paralysis of muscles supplied at spinal level
• Dorsal column medial lemniscus- ipsilateral loss of vibration, proprioception and fine touch
• Spinothalamic tract- contralateral loss of pain and temperature sensation : 1-2 levels below lesion due to damage of lateral spinothalamic tract
• Ipsilateral loss of motor and sensory function use at the level of the injured segments due to direct damage to ventral and dorsal grey matter

Question 13

Features of upper motor neuron disorder

Answer 13

Spasticity
Spastic weakness
Brisk reflexes
Positive Babinski reflex

Question 14

Common causes of UMN damage

Answer 14

Brain/brain stem- stroke, tumours, demyelination (MS)
Spinal cord - MS, cord compression, spinal cord degenerative causes = Hereditary spastic paraparesis, vitamin B12 deficiency

Question 15

Features of lower motor neuron disorder

Answer 15

Weakness- flaccid
Reduced tone
Muscle wasting
Fasciculations
Absent deep tendon reflexes

Question 16

Causes of LMN injury

Answer 16

Motor neuron - MND , polio
Motor nerve roots- radiculopathy, Guillain Barre syndrome
Motor nerves- neuropathies, radiculopathies
Neuromuscular junction disorder - Myasthenia gravis
Muscle disorders- Myositis, myopathies

Question 17

Idiopathic Parkinson’s disease clinical presentation (TRAP)

Answer 17

Tremor
Rigidity
Akinesia/ bradykinesia
Postural instability

Constipation, loss of sense of smell, impaired taste, sexual dysfunction

Question 18

Features of impaired peripheral nerve and neuromuscular junction

Answer 18

Numbness , tingling, burning, freezing pain
Weakness and muscle wasting
Poor balance
Deformities secondary to weakness

Question 19

Causes of peripheral nerve damage

Answer 19

Diabetes
Idiopathic
Leprosy
HIV
Deficiency states eg B12 folate
Alcohol/toxins/drugs
Hereditary neuropathies
Paraneoplastic syndromes
Metabolic abnormal - porphyria

Question 20

Myasthenia gravis

Answer 20

Antibody mediated neuromuscular junction disorder

Question 21

Where would the lesion be if it results in total blindness in the left eye

Answer 21

Left optic nerve

Question 22

When will a person with damage to CN IV complain of double vision

Answer 22

When they look down

Question 23

Ptosis of the eyelid due to

Answer 23

Damage of CN III on same side

Question 24

Damage to which nerve will result in loss of the corneal (blink) reflex on the affected side

Answer 24

Trigeminal (V)
Innervated by ophthalmic nerve- nasociliary branch and VII temporal and zygomatic branches

Question 25

In which type of lesion are forehead muscles spared

Answer 25

UMN lesion

Question 26

Symptoms of Bell’s palsy

Answer 26

Droopy eyelid, dry eye or excessive tears
Facial paralysis, twitching or weakness
Drooping corner of mouth, dry mouth, impaired taste

Question 27

Which nerve causes nystagmus (rapid eye movements) when diseased

Answer 27

Vestibulocochlear (CN VIII)

Question 28

Tumour of the vestibulocochlear nerve

Answer 28

Cause paralysis of muscles of facial expression (compresses CN VII)

Question 29

Damage to Hypoglossal nerve

Answer 29

Paralysis of the ipsilateral half of tongue (‘licks the lesion’)

Question 30

Brown-Sequard syndrome leads to two-point discrimination appreciation below level of the lesion on

Answer 30

The same side- DCMLs decussates in meddulla

Question 31

Brown-Sequard syndrome leads to…

Answer 31

Same side hemiplegia

Question 32

Brown-Sequard syndrome leads to loss of pain and temperature appreciation on the

Answer 32

Opposite side
Spinothalamic tract crosses from 2 vertebral segments below

Question 33

Brown-Sequard syndrome leads to loss of proprioceptive information conveyed to the

Answer 33

Ipsilateral cerebellum
Spinocerebellar tract projects ipsilaterally

Question 34

Damage to the semi-circular canals results in

Answer 34

Nystagmus with the slow phase towards the damaged side and the rapid rest away from it

Question 35

Cerebellar lesions have a….. effect

Answer 35

Ipsilateral

Question 36

Damage to the papez circuit will mainly affect which function

Answer 36

Memory

Question 37

CN V lesion

Answer 37

loss of facial sensation
loss of corneal reflex
deviation of jaw towards the side of lesion
paralysis of mastication muscles

Question 38

CN III lesion

Answer 38

dilated, fixed pupil
a ‘down and out’ eye
ptosis

Question 39

CN VII lesion

Answer 39

loss of corneal reflex
loss of taste (anterior 2/3rds of the tongue)
flaccid paralysis of upper + lower face
hyperacusis

Question 40

A 48-year-old man with type 2 diabetes mellitus, who smokes 30 a day and is overweight presents with bilateral “glove and stocking” loss of pain, temperature and pin prick sensation.

Which of the following spinal tracts is affected?

Answer 40

Spinothalamic

Question 41

A sexually active 75-year-old gentlemen presents with a stamping gait. He is diagnosed with tabes dorsalis. On examination he has a loss of joint position sense and cannot feel the tuning fork (vibration) when placed on his medial malleolus.

Which of the following spinal tracts is affected?

Answer 41

Dorsal column medial lemniscus pathway

Question 42

A 73 year old lady presents to her GP surgery with an intensely itchy vesicular rash in a horizontal line at the level of the nipple.

What is the most likely diagnosis?

Answer 42

Shingles

Question 43

Damage to the LEFT VIth cranial nerve causes double vision. Which of the following is the most likely problem for the patient?

Answer 43

Double vision which is worse when looking to the left

Question 44

A 47 year old patient with severe rheumatoid arthritis attends her General Practitioner with numbness of the distal upper limb. The pattern of numbness does not fit with a spinal nerve root or a peripheral nerve lesion. Damage to which tract of the spinal cord may lead to this pattern of sensory loss?

Answer 44

Cuneate fasciculus (lateral posterior column tract)