Clinical Localisation & Neuroanatomy ; Lecture

Question 1

What are the three steps of the neuro-diagnostic pathway?

Answer 1

Clinical syndrome.
Imaging/Investigation (e.g., CT, MRI, lumbar puncture, EMG).
Underlying pathology.

Question 2

True/False: Neuro-clinical syndromes should always be separated from the underlying disease entity.

Answer 2

True.

Question 3

List five examples of neuro-clinical syndromes.

Answer 3

Proximal myopathy.
Cerebellar syndrome.
Cranial nerve palsies.
Extrapyramidal syndromes.
Raised ICP syndrome.

Question 4

_________ syndrome includes symptoms such as ataxia and nystagmus, which occur on the _________ side of the lesion.

Answer 4

Cerebellar; same (ipsilateral).

Question 5

Match the syndrome to its typical symptom.

Myelopathy.
Raised ICP syndrome.
Parkinsonism.
Meningism.

Answer 5

Myelopathy: Treacle hands, Brown-Sequard.
Raised ICP syndrome: Headache, vomiting, visual disturbance.
Parkinsonism: Bradykinesia, rigidity, tremor.
Meningism: Neck stiffness, headache, photophobia.

Question 6

What are the normal CSF production rate and total CSF volume?

Answer 6

Production: 500 mL/24 hours.
Total volume: 120 mL.

Question 7

The _________ fissure separates the frontal and parietal lobes, while the _________ sulcus separates the parietal and temporal lobes.

Answer 7

Sylvian; central.

Question 8

What is the most common presentation of stroke involving the internal capsule?

Answer 8

Sudden onset of contralateral hemiparesis.

Question 9

Middle cerebral artery strokes typically result in _________ deficits, while anterior choroidal artery strokes cause _________ deficits.

Answer 9

cortical; internal capsule.

Question 10

What are the components of a mini-neurologic examination?

Answer 10

Glasgow Coma Scale (GCS).
Lateralizing signs.
Pupil assessment.

Question 11

True/False: Fixed, dilated pupils are commonly associated with 3rd nerve palsy.

Answer 11

true.

Question 12

Match the spinal root to its corresponding reflex and sensory area:

C6.
C7.
S1.

Answer 12

C6: Biceps reflex, thumb sensation.
C7: Triceps reflex, middle finger sensation.
S1: Ankle jerk reflex, lateral foot sensation.

Question 13

Cervical radiculopathy affecting the _________ root causes elbow flexion weakness, while _________ radiculopathy affects ankle jerk reflex.

Answer 13

C6; S1.

Question 14

What are two symptoms and two signs of raised ICP?

Answer 14

Symptoms: Headache, visual disturbance.
Signs: Papilledema, limitation of upward gaze.

Question 15

True/False: Hydrocephalus may occur in raised ICP due to infratentorial lesions.

Answer 15

true

Question 16

Name the key structures involved in the descending motor pathway.

Answer 16

Pyramidal decussation.
Corticospinal tract.
Internal capsule.

Question 17

The _________ tract carries sensory information for pain and temperature, while the _________ columns carry vibration and proprioception.

Answer 17

lateral spinothalamic; posterior.

Question 18

What is the rule of thumb for differentiating spine and brain pathology?

Answer 18

Spine: Radiating limb pain, bilateral limb deficit, back pain.
Brain: Headache, visual disturbances, contralateral deficits.

Question 19

A patient with “treacle hands” and _________ suggests a _________ lesion.

Answer 19

Brown-Sequard syndrome; myelopathy.

Question 20

What are the key imaging modalities in the neuro-diagnostic pathway?

Answer 20

CT, MRI, lumbar puncture, EMG/nerve conduction studies, cerebral angiography.

Question 21

What are dermatomes, and why are they clinically important?

Answer 21

Dermatomes are areas of skin innervated by a specific spinal nerve root, helping localize neurological lesions.

Question 22

Myotomes refer to muscles innervated by a particular _________, and they can be assessed by testing _________.

Answer 22

spinal nerve root; specific movements.

Question 23

What does the mnemonic “LOAF” stand for in relation to the median nerve motor supply?

Answer 23

Lateral 2 lumbricals.
Opponens pollicis brevis.
Abductor pollicis brevis.
Flexor pollicis brevis.

Question 24

The axillary nerve (C5) innervates the _________, which is responsible for _________ of the shoulder.

Answer 24

deltoid; abduction.

Question 25

True/False: The radial nerve innervates the triceps and finger extensors and arises from the posterior cord.

Answer 25

True.

Question 26

What causes scapular winging?

Answer 26

Nerve lesions: Long thoracic (serratus anterior), accessory (trapezius), dorsal scapular (rhomboids).
Primary muscle pathology (e.g., myopathy).

Question 27

Scapular winging caused by a _________ nerve lesion is most common and affects the _________ muscle.

Answer 27

long thoracic; serratus anterior.

Question 28

A 68-year-old man has elbow extension weakness and numbness over the middle finger. MRI shows a nerve root lesion. What is the likely root affected?

Answer 28

C7.

Question 29

A 52-year-old man has weak dorsiflexion and ankle inversion with normal knee extension. Where is the lesion?

Answer 29

L4/5 root or common peroneal nerve.

Question 30

Wrist drop with normal elbow extension and numbness over the _________ suggests a _________ nerve lesion.

Answer 30

anatomical snuffbox; radial.

Question 31

What are the possible causes of foot drop?

Answer 31

Muscle: Myopathy.
Nerve: Peroneal nerve, sciatic nerve.
Root: L4/5.
Anterior horn: Motor neuron disease.
Brain: Parasagittal meningioma.

Question 32

True/False: L4/5 lesions often present with combined sensory and motor deficits, affecting dorsiflexion and inversion.

Answer 32

True.