CIS 3 Flashcards
Motorcycle accident w/no helmet. Severe head injury, verbally abusive, combative state, semi-comatose state. Skull x-ray indicated linear fracture or right temporal bone.
Pt has dilated a-reflexive right pupil, and hyporeflexia of left extremities
Epidural hematoma
Note: Do NOT perform doll’s eye maneuver on pt with suspected cervical injury
Difference between falx, uncal and tonsilar herniation?
falx midline shift, uncal shifts down, tonsilar (most severe) shifts down and out thru foramen magnum
High school wrestler, complained of exertional headaches for one week after injury to the right orbital area during a match. Ecchymosis and headache, but did not lose consciousness. A/ox4, cranial nerves normal, normal pupillary response, flat optic disks. Initial dx was “post-concussive headache”, movements to the right seemed slow. 4 days later pt came back with four day severe bi-temporal throbbing headache
Subdural hematoma
CT scan showed space-occupying mass in left parietal region along with a midline shift of the ventricles and falx cerebri to the right (goes beyond boundaries of sutures of skull)
Abrupt onset of severe headache and difficulty walking, followed by rapid loss of consciousness, nuchal rigidity and positive Kernig’s sign. Lumbar puncture yielded bloody CSF. Fever, rigid neck, normal Doll’s Head maneuver. CT scans show aneurysms on right MCA and right ICA, ventricles normal size, pt vomited. Pt died the next day
Subarachnoid hemorrhage
Left-handed secretary suddenyl became unable to support her weight on left leg, shumbled and fell. Flaccid paralysis of left leg, minimal weakness of left-hand grip, left Babinski’s sign. CSF clear and colorless. MRI showed hyperintensity in ACA territory, midline shift
Spastic hemiplesia
Anterior cerebral peduncles are pushed on my tentorium cerebelli (Kernahan’s notch). Downward herniation will crush the midbrain
Bicyclist crashed into wall. Bilateral neck fractures of necks of mandible and compression fractures of transverse processes of atlas. Dysarthria, dysphagia and difficult breathing, paresis and numbness in all four extremities
Vertebral basilar insufficiency
History of HTn, collapsed in parking lot of building. Hemianalgesia and thermal hemianesthesia of left side of body and face. Proprioceptive/2pt tactile sesations absent from left side of body, slightly diminished on left side of face. Slow pain sensations vaguely perceived on left side body and face. Left spastic hemiplegia with hyperreflexia and Babinski, inability to smile on left, left homonymous hemianopsia
Basal ganglia, internal capsule infarction
1 year history of decreasing interest in caring for her house and personal needs. Uncharacteristic changes in behavior, APATHY. Answered all questions with single word responses, slow shuffling gait, incontinence. CN’s all normal, but food seemed tasteless
Frontal lobe syndrome (prefrontal tumor)
History of multiple strokes, including some in parieto-temporal cortex (aphasic zone). Automatic speech patterns are intact, intellectual abilities are appropriate
Wernicke’s aphasia
2 year history of insidious onset of forgetfulness and impaired judgement, occasional disorientation in time and place. Needs basic assistance with daily tasks, has urinary incontinence. Marked disorientation in time and space, mixed aphasia, apraxia, pathologic mouth-opening responses, grasps reflex on the right, hyperreflexia of all extremities. CT scan showed marked dilation of ventricle and subarachnoid space
Dementia: 9 months post herpes encephalitis
Pt wandering aimlessly. Walking to work, last thing he remembers was walking to work, smelled something burning, seeing gigantic trains running up and down the hallway. He began hallucinating and suffered amnesia and nightmares.
Left superior homonymous quadrantanopia (disorder of anterior temporal cortex
Severe “thunderclap” headache, double vision and trouble walking for last two weeks. Nausea/vomiting during last month. Exam revealed bilateral papilledema, bilateral paresis of lateral gaze, tilting of head to the left, Romberg test positive to left, wide-based ataxia of trunk musculature.
Medulloblastoma of 4th ventricle (common in kids, but can present later)
A/ox4, poorly nourished pt complains of clumsiness and difficulty walking, disoriented with respect to time and place. Scored poorly on first section of MMSE, passed Romberg, has broad ataxic gait. Dysmetria on finger to nose test, uncoordinated movements on heel to shin test, dysdiadochokinesia
Alcoholic cerebellar degeneration (Korsekoff’s syndrome affects mammillary bodies b/l)
Trembling hands, general stiffness of limbs. Masked facial expression and stare, shuffling gait, difficulty initiating movements, pill-rolling tremors of both hands, bilateral rigidity
Parkinson’s disease
Pt complains of involuntary movements in right arm. Violent flinging movements or upper right limb, which originated at the shoulder and elbow. Upper limb muscles appeared almost flaccid and hypotonic between movements.
Unilateral hemiballismus
