brain lesions Flashcards by Makenzie Kresch

Visual problem in pituitary tumor compressing optic chiasm (10x)

BITEMPORAL HEMIANOPSIA

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Unsteady gait, appendicular ataxia in LE only and normal eye movement. Walks with
lurching broad-based gait. (8x)

CEREBELLAR DEGENERATION

ALCOHOLIC

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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

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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

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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

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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

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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

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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

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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

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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

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5 y/o with 4 month history of morning HA, vomiting, and recent problems with gait, falls,
and diplopia: (2x)

MEDULLOBLASTOMA

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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

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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

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Superior homonymous quadrantic defects in the visual fields result from lesions to which
of the following structures? (2x)

TEMPORAL OPTIC RADIATIONS

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Tremor with a frequency of around 3 Hz, irregular amplitude, most evident towards the
end of reaching movements: (2x)

CEREBELLAR TUMOR

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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

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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)

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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

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Benign intracranial HTN etiology: (2x)

HYPERVITAMINOSIS A

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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

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HERPES ENCEPH

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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

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What condition is a forerunner of MS? (2x)

TRANSVERSE MYELITIS

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Head injury with personality changes, impulsivity and euphoria. Site of injury?

ORBITOFRONTAL CORTEX

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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

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)

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

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