Clinical vignettes (2)

Question 1

CASE 1 What usually causes sudden events

Answer 1

Vascular issues- strokes

Question 2

What does cranial nerve involvement imply

Answer 2

brainstem vascuar issue

Question 3

What is dysarthria vs dysphasia

Answer 3

slurring words vs wrongly pronounced/wrong words

Question 4

Which cranial nerve involved in ptosis

Answer 4

loss of sympathetic function 
oculomotor damage (3)- innvervates levator palpebrae
Myasthenia gravis (fatigue)

Question 5

Can’t move right eye in or upwards

Answer 5

Oculomotor loss as well

Question 6

Why can pupils be unaffected while eye movements and eyelid opening

Answer 6

Because parasympatehtic inervation to the pupil (constrict) run separately in the 3rd cranial nerve….. ….. aneurysm usually involves parasympathetic (in posterior communicating artery, which sits under the 3rd cranial nerve, hits the parasympatehtic fibres on teh underside of oculomotor nerve)

so pupil sparing right side 3rd nerve palsy

Question 7

Weakness of left corner of mouth

Answer 7

cranial nerve 7

Question 8

Corneal reflex and jaw jerk reflex

Answer 8

V1 and v3

Question 9

shoulder shug reflex

Answer 9

12

Question 10

Mild weakness in left arm and leg… left leg is increased reflex… left babinski response, abdominal reflex absent on the left

Answer 10

upper motor neuron affected…. corticospinal tract

Question 11

Involvement of right 3rd nerve, and corticospinal tract on the right, causing left sided weakness

Answer 11

…..

Question 12

Which area of brainstem involved

Answer 12

midbrain (oculomotor nerve emerges from here)= vabers syndrome

Question 13

CASE 2

What can cause you to fall over

Answer 13

cerebellar dysfunction

paralysis

Question 14

Sudden onset weakness in right leg (stiff) and some weakness in right arm

Answer 14

…

Question 15

Left side of face weakness and drooling

Answer 15

..

Question 16

Long term alcoholism affects which area

Answer 16

Cerebellum (so cerebellar speech)

Question 17

Conjugate vision

Answer 17

eyes moving together

Question 18

No conjugate vision to the left

Answer 18

nuclear 6th nerve palsy (gaze palsy)

Question 19

6th nerve nucleus

Answer 19

signal from the cortex to the left 6th nerve nucleus to move eye to left…. then a signal from 6th nerve nucleus goes to right oculomotor nucleus, and tells it to oculomotor nerve to move right eye to the left

Question 20

Where are 6th nerve nuclei

Answer 20

in the pons

Question 21

Corticospinal tract lesion posture

Answer 21

flexion of the leg and increased tone so curled up arm

Question 22

Stroke causing headache

Answer 22

haemorrhagic… increases intracranial pressure

Question 23

What would neck trauma have to do with stroke

Answer 23

Dissection invertebral or internal carotid artery…. can cause turbulent flow or clots/thrombus

Question 24

Where is carotid artery dissection felt vs vertebral artery

Answer 24

carotid= side of face and neck 
Vertebral= neck and back of head

Question 25

Commonst cause of young person stroke

Answer 25

Dissection (as few vascular risk factors)

Question 26

Link between diabetes and blood vessels

Answer 26

early atheroma

Question 27

Effect of diabetes on eyes

Answer 27

diabetic retinopathy and cataracs

Question 28

How does diabetes affect sensation

Answer 28

Peripheral neuropathy

Question 29

Which area of brain fixes gaze

Answer 29

cerebellum

Question 30

Horners syndrome nervous system affected

Answer 30

horners syndrom

Question 31

eye in horners

Answer 31

eyelid a bit droopy, cant ompletely open and pupil small

Question 32

Limb dysmetria and gait ataxia

Answer 32

cerebellar dysfunction

Question 33

Pin prick diminished on right hand side

Answer 33

spinothalamic sensory involvement

Question 34

case 3

Answer 34

left posterior inferior cerebellar artery