ESTHER AND HER PATTERN RECOGNITION

Question 1

Muscle tone in UMN / LMN lesions

Answer 1

Increased in UMN

Normal or decreased in LMN

Question 2

UMN corticospinal pattern of weakness

Answer 2

= weak extensors in the arms, weak flexors in the legs

Question 3

Key thing about neuromuscular junction disease

Answer 3

NO SENSORY SYMPTOMS !!!

Question 4

Hemianaesthesia: where is the lesion?

Answer 4

Contralateral cerebral lesion, or with no other signs, a non-organic disorder

Question 5

Sensory level sensory loss: where is the lesion

Answer 5

Spinal cord lesion

Question 6

Stocking (and later glove) sensory loss - what type of neuropathy?

Answer 6

This implies length dependent neuropathy

Question 7

Dissociated sensory loss with lost spinothalamic (temperature/pain) but with preserved dorsal column (vibration, light touch, proprioception) suggests what kind of damage?

Answer 7

Hemicord damage

e.g. anterior spinal artery syndrome, Brown sequard syndrome, syringomyelia

Question 8

Difference between extrapyramidal symptoms in PD and drug induced/atypical PD

Answer 8

• Symptoms are asymmetrical in PD

- Symptoms are symmetrical in drug induced or atypical PD

Question 9

Extra-pyramidal/parkinsonism symptoms?

Answer 9

• bradykinesia
• rigidity, tremor
• hypophonia
• hypomimia
• shuffling gait
• reduced arm swing
• impaired postural reflexes
• small steps
• festination
• turning en bloc

Question 10

Damage to which part of the brain causes disinhibition?

Answer 10

The orbitofrontal cortex (this part of the brain is responsible for primitive function e.g. hunger, thirst, sexual function)

Question 11

Damage to which part of the frontal lobe causes disinhibition?

Answer 11

Orbitofrontal cortex

Question 12

Which part of the frontal lobe is responsible for response to external stimuli (working memory, cognitive flexibility, decision making etc)?

Answer 12

Dorsolateral prefrontal cortex

Question 13

Which part of the frontal lobe is responsible for motivation and what does damage to this part cause?

Answer 13

Cingulate gyrus and dorsomedial frontal lobe

Damage causes abulia (lack of will) or even akinetic mutism

Question 14

The following symptoms may result from damage to which part of the brain? :

• personality dysfunction
• paraparesis
• paratonia
• grasp reflex
• frontal gait dysfunction
• cortical hand
• seizures
• incontinence
• visual field defects (anterior visual pathway incl optic chiasms are beneath frontal lobe)
• expressive dysphasia (Broca’s area is in the dominant frontal lobe)
• Anosmia (olfactory pathway is found beneath frontal lobes)

Answer 14

Frontal lobe

Question 15

Damage to the temporal lobe results in impairments in which type of memory specifically?

Answer 15

Episodic

Question 16

Nystagmus and dysarthria are features of which disorders

Answer 16

Cerebellar disorders

Question 17

How can you test intention tremor?

Answer 17

With finger-nose test and in the leg by knee-heel testing

Question 18

Which side of the brain is the speech centre in?

Answer 18

In the left (dominant) hemisphere in about 99% of right handed people

Question 19

The 4 primary symptoms of Gerstmann’s syndrome

Answer 19

• Dysgraphia/agraphia (inability to write)
• Finger agnosia (can’t distinguish fingers on hand)
• Dyscalculia: can’t learn/comprehend mathematics
• Left-right disorientation

Question 20

Imaging for MS

Answer 20

MRI imaging including gadolinium contrast

Question 21

Treatment for acute relapses of MS

Answer 21

High dose steroids (oral or IV)

Question 22

Frequent presenting symptoms in MS

Answer 22

• visual compromise
• stiffness
• weakness

Question 23

Oligoclonal bands and MS

Answer 23

Oligoclonal bands are found in the CSF of MS patients but these are also found in other conditions

Question 24

When might MS symptoms be worse?

Answer 24

Symptoms may worsen with fever or higher temperatures

Question 25

A pure upper motor neuron syndrome

Answer 25

Primary lateral sclerosis

Question 26

Stroke imaging method to identify old lesions and lesions of non-vascular origin

Answer 26

MRI T1/T2 and FLAIR images

Question 27

Which type of imaging in stroke will identify new ischemic lesions and how will they show up?

Answer 27

Diffusion weighted images identify new ischemic lesions and they will appear hyperdense
-there will also be a decrease in signal on the apparent diffusion coefficient of water

Question 28

Which weighting of image will identify bleeds and microbleeds?

Answer 28

T2

Question 29

Which imaging sequences will identify occlusions of the extra- and intracranial arteries

Answer 29

Time of flight sequences

Question 30

What are perfusion weighted images (PWI) useful for?

Answer 30

Useful for identifying brain areas at risk of ischemia

Question 31

Criteria for lacunar syndromes

Answer 31

• no visual field defect
• no new higher cortical or brainstem dysfunction
• pure motor hemiparesis, or pure sensory deficit of one side of the body, or sensorimotor hemiparesis or ataxic hemiparesis (dysarthric clumsy hand syndrome or ipsilateral ataxia with crural hemiparesis)

Question 32

Cranial nerve palsy

Answer 32

Posterior circulation

Unilateral or bilateral motor or sensory deficit

Question 33

Cerebellar dysfunction

Answer 33

Posterior circulation

Question 34

Isolated homonymous hemianopia

Answer 34

Posterior circulation

Question 35

Cortical blindness

Answer 35

Posterior circulation