brain lesions Flashcards
Visual problem in pituitary tumor compressing optic chiasm (10x)
BITEMPORAL HEMIANOPSIA
Unsteady gait, appendicular ataxia in LE only and normal eye movement. Walks with
lurching broad-based gait. (8x)
CEREBELLAR DEGENERATION
ALCOHOLIC
Severe occipital HA, BL papilledema and no other abnormalities. Chronic acne treated
with isotretinoin. Lumbar puncture elevated opening pressure with no cells, 62 mg/dl
glucose, and 22mg/dl protein. CT is normal. (7x)
PSEUDOTUMOR CEREBRI
66 y/o c/o 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 &
minimal rigidity of upper extremities, along w mild slowness of movement on finger
tapping, hand opening & wrist opposition. Posture nml. Gait tentative/awkward, but w/o
shuffling, ataxia, tremor. Pt is slow in arising from a chair. Most likely dx: (7x)
PROGRESSIVE SUPRANUCLEAR PALS
79 y/o pt with a deteriorating mental state over a 3-week period has an exaggerated
startle response with violent myoclonus that is elicited by turning on the room lights,
speaking loudly, or touching the pt. Myoclonic jerks are also seen. Diagnosis: (5x)
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
diagnosis? (4x)
nph
65 y/o pt fell several times past 6 mos. MSE nml. Smooth pursuit, saccadic movements
impaired. Worse w vertical gaze. Full ROM w doll head maneuver. Mild symmetric
rigidity/bradykinesia, no tremor. MRI/CSF/labs unremarkable. Dx? (4x)
PROGRESSIVE SUPRANUCLEAR PALSY
28y/o with emotional lability and impulsivity. LFT’s elevated. Close relative had similar sx
and died at 30y/o from hepatic failure. Which blood level would be
diagnostic? (3x)
CERULOPLASMIN
Pt w/ 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 wks. Likely to develop later: (3x)
MULTIPLE SCLEROSIS
9 y/o F has 3 month h/o seemingly unprovoked bouts of laughter. Worse when not
sleeping well. Pt does not feel happy during these episodes. Started menstruating 6
months ago, and at Tanner stage 4. Dx? (2x)
HYPOTHALAMIC HAMARTOMA
5 y/o with 4 month history of morning HA, vomiting, and recent problems with gait, falls,
and diplopia: (2x)
MEDULLOBLASTOMA
70 y/o develops flaccid paralysis following severe water intoxication. He develops
dysphagia and dysarthria without other cranial nerve involvement. Sensory exam is
limited but grossly normal, DTR’s are symmetric, and cognition is intact. Likely dx: (2x)
CENTRAL PONTINE MYELINOLYSIS
Young adult gained 70 lbs in last year c/o daily severe headaches sometimes associated
with graying out of vision. Papilledema present. CT and MRI brain no abnormalities but
ventricles smaller than usual. Goal of treatment in this case: (2x)
prevent blind
Superior homonymous quadrantic defects in the visual fields result from lesions to which
of the following structures? (2x)
TEMPORAL OPTIC RADIATIONS
Tremor with a frequency of around 3 Hz, irregular amplitude, most evident towards the
end of reaching movements: (2x)
CEREBELLAR TUMOR
Pt with several days of fever and severe headaches presents to ED b/o generalized
seizure. Pt is confused and somnolent. Also reported to have been irritable and has c/o
foul smells. T2 MRI displayed (hyperintensity of left temporal): (2x)
herpes enceph
Acute onset of fever, sore throat, diplopia, & dysarthria. Exam reveals an inflamed throat,
left adductor nerve palsy w/ impairment of vertical pursuit, diffuse hyperreflexia w/
bilateral clonus, lower ext spasticity, & mild right hemiparesis. CT is uninformative. Spinal
fluid has protein of 24, 10 mononuclear cells, and glucose of 70. Dx? (2x)
MS
Which is the most reliable finding from CSF analysis for a pt with multiple sclerosis in the
chronic progressive phase of the dz? (2x)
oligoclonal bands
Benign intracranial HTN etiology: (2x)
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 & vertical gaze. Oculocephalic reflexes normal. Involuntary
saccades. (2x)
PROGRESSIVE SUPRANUCLEAR PALS
Pt with several days of fever and severe headaches presents to ED b/o generalized
seizure. Pt is confused and somnolent. Also reported to have been irritable and has c/o
foul smells. T2 MRI displayed (hyperintensity of left temporal): (2x)
HERPES ENCEPH
Pt presents with personality changes, cognitive difficulties, affective lability, and olfactory
and gustatory hallucinations. The most likely medical cause of this presentation is: (2x)
hsv ENCEPH
What condition is a forerunner of MS? (2x)
TRANSVERSE MYELITIS
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: placisity, hyperorality, hypersexuality and hyperphagia, can be
induced in animals with bilateral resection of which structure?
TEMPORAL LOBES
Most common psych complication from TBI
DEPRESSION
Executive dysfxn comes from damage to?
FRONTO-SUBCORT
36 yo pt w/ double vision, vertigo, vomiting, paresis of medial rectus on lateral gaze w/
coarse nystagmus in abducting eye w/ lateral eye movement
ms
35 yo pt w/ new onset headache, what suggests mass lesion w/ raised ICP?
PAPILLEDEMA
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? (x2)
BROCA’S APHASIA
5 y/o presents w/ sudden onset of slurred speech and gait difficulty. Exam shows truncal
ataxia and nystagmus, mild dysarthria and extensor plantar responses. Recent h/o measles.
MRI, UA, blood work 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
Inability to recognize objects by touch:
ASTEREOGNOSIS
Which cancer has the highest likelihood of going to brain?
LUNG
Etiology of meningitis assoc with fever, HA, CSF pleocytosis with lymphocyte predominance,
slightly elevated CSF protein, and normal CSF glucose
COXSACKIE
Most common solid tumor of the CNS in kids
NEUROBLASTOMA
75 yo 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 chronic fatigue, cognitive impairment, reduced perceptual motor speed, poor effort
maintenance, and irritability (MRI: 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 occipital region. Exam: b/l
severe papilledema, otherwise WNL. LP: opening pressure: 200mmH2O, no cells, 62mg/dl
glucose, 31 mg/dl protein. CT: normal. Dx?
IIH
Histology consistent with Jakob-Creutzfeldt disease
CYTOSOLIC VACUOLATION OF NEURONS
AND GLIA WITH PRION INCLUSIONS
Dx for 68yo c/o falls. PE shows upright rigid posture, stiff gait, extended knees, and pivoting
while turning.
PROGRESSIVE SUPRANUCLEAR PALSY
Diagnosis of 32yo woman w/ vertigo and INO
ms
A 66 yo complains of frequent falls. ON exam, the pt has difficulty with upward gaze, and
has severe axial rigidity which is less apparent in upper or lower extremities. There is mild
slowness of movement on finger tapping, hand opening and wrist opposition and the
patient’s fingers acquire cramped pastures with the effort of the task. The pt’s neck posture
is extended. Gait is somewhat slow, with short steps, and The pt is slow when arising from a
chair. What is most likely diagnosis?
PROGRESSIVE SUPRANUCLEAR PALSY
70 y/o pt develops confusion, lethargy, and generalized tonic-clonic seizure. Lab reveals
serum sodium of 95mEq/L. This is most likely a complication of excessively rapid correction
of which metabolic problem?
CENTRAL PONTINE MYELINOLYSIS
Hippocampal atrophy has been identified in all of the following disorders:
MDD, ALZHEIMER’S DISEASE, PTSD.
NOT DISSOCIATIVE AMNESIA
Severe occipital HA, BL papilledema and vomiting. Just started birth control pills. Lumbar
puncture elevated opening pressure with no cells, 62 mg/dl glucose, and 31mg/dl protein,
RBC 400. CT is normal.
SAGITTAL SINUS THROMBOSIS
Condition most likely to account for the presence of cognitive impairment in a pt with
untreated Hep C (HCV) infection and normal ammonia level who is HIV sero- negative:
hcv brain
Delayed neurological deterioration following carbon monoxide-induced coma is most likely
manifested by:
PARKINSONISM
Causative agent of progressive multifocal leukoencephalopathy (PML):
JC virus
Location of characteristic lesions seen in CT scans of pt with carbon monoxide poisoning
associated comas?
GLOBUS PALLIDUS
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 opening pressure 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 show 35 WBC, lymphocytosis and the
protein level is 110mg/Dl and elevated gamma globulin. Dx:
neurosyphilis
Inability to carry out motor activites on verbal command despite intact comprehension &
motor function indicates?
apraxia
80yo pt is unable to blow out match although motor and sensory function are normal. What
is this called?
apraxia
25 y/o M w 7 months depression, forgetfulness, weight loss, insomnia, painful tingling in
both feet+incoordination. Involuntary choreic movements of B/L UE, apathetic,
monosyllabic. Labs normal. EEG: mild diffuse slowing. CT/MRI nml. During admission
develops severe akinetic mutism, seizures, dies. Brain autopsy shows:
DIFFUSE AMYLOID PLAQUES,
SPONGIFORM NEURONAL
DEGENERATION, AND SEVERE
ASTROGLIOSIS
52 y/o pt with EtOH dependence present with several days of severe headache, nausea, and
low grade fever. Physical exam reveals mild disorientation, nuchal rigidity, and mild
spasticity in the lower extremities. A head CT is unrevealing. LP:
55/mm3 leukocytes (mostly lymphocytes), 45 mg/dl glucose, protein: 43 mg/dl, and
presence of occasional gram positive spherical cells. The most likely causative organism is:
CRYPTOCOCCUS NEOFORMANS
CT & MRI show ventriculomegaly are out of proportion to sulcal atrophy. This is suggestive
of what diagnosis?
nph
49 y/o pt with ETOH dependence is brought to the ED with a one-week history of malaise,
headache, diplopia, lethargy and confusion. On examination, the pt has a temp of 38.2 C,
stiff neck, medical deviation of the right eye with impaired abduction and hoarseness. CSF:
114 leukocytes, predominantly monocytes, a protein of 132mg/dl, and glucose of 29mg/dl.
Likely type of meningitis:
tuberculous
Closed TBI, initially no LOC, then 20 minutes 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 following 20min.The next day, pt reported a headache
and irritable, neuro exam normal. Best recommendation to family about pt:
SHOULD BE EXAMINED IN 2 WKS BEFORE
RESUMING PLAY
In ER following MVA, receives IV dextrose 5%. Experiences confusion, oculomotor paralysis,
and dysarthria:
WERNICKE’S ENCEPHALOPATHY
Which of following is invariably the first manifestation of neurosyphilis?
MENINGITIS
14 y/o @ summer camp develops severe headache and fever, drowsiness, stiffness of neck
on passive forward flexion, petechial rash and skin pallor. Spinal tap reveals opening
pressure 200mm H20, 84%neutrophils (7,000 nucleated cells), glucose level of 128mg/dl,
and protein level of 33mg/dl. Most likely causative agent?
MEN:INGOCOCCUS
Which hormone is secreted in functional pituitary adenoma:
prolactin
Primary characteristic of Wernicke encephalopathy
acute onset
52 y/o M presents with a chief complaint 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 WWII veteran w/ gradual onset forgetfulness, intellectual deterioration, fast/slurred
speech, gait impaired, CT with normal atrophy. LP: 35WBCs (most lymph), protein 110,
increased gamma globulin. Dx?
NEUROSYPHILIS
41 y/o pt w/o family h/o corticocerebellar degeneration presents with 3-month h/o ataxia
of gait/limbs, dysarthria, and progressive nystagmus. MRI and CSF normal. 1) Antibody
panel with presence of? 2) What type of tumor is likely present?
1) ANTI-YO
2) OVARIAN CARCINOMA
MRI finding for woman with memory decline, urinary incontinence, and trouble walking
DILATION OF VENTRICLES
Effortful, nonfluent 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 would show
LESION IN GLOBUS PALLIDUS
Which of the following tests is recommended by the American Academy of Neurology to
establish the diagnosis of brain death?
APNEA TEST
Essential criterion for declaration of brain death prior to organ donation requires?
APNEA TEST
43 y/o newly AIDS pt has increasing social withdrawal and irritability over several weeks.
Can’t remember phone number, unable to do chores, appears distracted. Mild right
hemiparesis, left limb ataxia, and bilateral visual field defects. LP: normal cell counts,
protein, and glucose. T2 Scan is shown. What is the diagnosis:
PROGRESSIVE MULTIFOCAL
LEUKOENCEPHALITIS
Risk factor for depression in MS patient
LESION VOLUME
Right handed pt recently underwent neurosurgery is now unable to name objects in left
hand when blind folded. He was able to name them when displayed on a screen. Where was
the surgery?
CORPUS CALLOSUM
Bilateral paresis of medial rectus muscle during lateral gaze with course nystagmus in
abducting eye characteristic of:
MULTIPLE SCLEROSIS
82 year old with progressive dementia, myoclonus over 3 months. EEG shows periodic sharp
waves with 1hz over both hemispheres. Dx?
CREUTZFELDT–JAKOB DISEASE
