ICS-CNS & PNS Disorder Localization Flashcards
A 76 year old man presents with hypertension, hypercholesterolemia, type II diabetes and rapid onset weakness and numbness in his right arm and right lower face. He could only produce a few words and was unable to understand what was said to him. What is your diagnosis?
The patient’s history of hypertension, hypercholesterolemia and type II diabetes put him at risk for stroke from a ruptured plaque. He has motor symptoms from the pre central gyrus, sensory symptoms from the post central gyrus and speech symptoms from the frontal and superior temporal lobes, so he likely had an occlusion of the left middle cerebral artery.
A 56 year old woman with known hypertension became furious at the store. Suddenly her left arm became weak and her left leg collapsed under her. Her speech became slurred. Physical exam reveals that she has no sensory loss, + Babinski on the left and she was able to take directions despite slurred speech. Her MRI is shown below. What is your diagnosis?
Her rapid onset, history of hypertension and focal symptoms are indicative of a possible stroke. She has a hemorrhage in the basal ganglia, compressing her internal capsule at the genu which causes contralateral hemiparesis. Note that she has no cortical signs (speech, sight) or sensory loss that help you know the lesion is not in the cortex.
An 80 year old man with metastatic cancer complains of double vision while eating dinner last night. His left hand became weak and he was unable to stand because of weakness in his left leg. Physical exam reveals dysarthria, weakness the the upper and lower portions of his right face and right eye inward deviation with inability to abduct the right eye. What is your diagnosis?
Metastatic cancer can create a hypercoaguable state and cause occlusion of arteries and stroke. Whenever you have long tract findings on one side and cranial nerve (VII) findings on the other, the lesion must be in the brainstem. This patient has a lesion in the right lower pons where CN VI, VII and VIII all exit.
Dysarthria
Weakness of the muscles of the mouth and face causing slurred speech.
A 32 year old man was running on the beach. He noticed that when he ran in one direction, the right foot that splashed in the water felt cold and when he ran in the other direction the left foot that splashed in the water did not feel cold. Physical exam reveals loss of pain sensation in the left hand. The left foot was weak, hyperreflexic and + Babinski. Pain and temperature sensation were diminished on the right extremities. Position and vibration sense were diminished in the right foot. What is your diagnosis?
He has a right-sided spinal cord hemisection, likely caused by a tumor due to focal symptoms with insidious onset.
A 45 year old actor is thrown from his horse and cannot move anything below his neck. He can look around but is having trouble breathing. Physical exam reveals muscular flaccidity and insensitivity to pain from the middle of the neck down. What is your diagnosis?
Complete spinal cord transection.
A 25 year old man has noticed increased clumsiness and occasional shaking of his left arm and hand. Physical exam reveals normal strength and sensation. Reflexes are normal. Finger to nose testing reveals a marked tremor in the left hand. What is your diagnosis?
The focal but insidious onset points you towards a tumor. She is showing symptoms of decrease proprioceptive ability.
What are the big three causes of peripheral neuropathies?
Diabetes, alcohol and thiamine deficiency.
A 40 year old man has been noticing progressive weakness for several months. Recently he notice twitching under the skin and atrophy of his hand muscles. Physical exam reveals no sensory loss. Nerve conduction tests are normal. EMG shows diffuse fibrillations and fasciculations. What structure is likely causing these symptoms?
Since the patient did not have any sensory loss and has fasciculations, this is indicative of alpha-motor neuron degeneration.
A 26 year old woman has tingling and weakness in her feet over the past three days. It improves over the next month, but does not completely resolve. Physical exam reveals normal reflexes and - Babinski. EMG shows mild muscle denervation and slowed nerve conduction. What is your diagnosis?
This patient has a mild form of Guillain-Barre syndrome characterized by slow demyelination of peripheral nerves that partially resolved.
A 6 year old boy has been losing athletic skills. Physical exam reveals moderate weakness of the muscles in his shoulders and hips. He has no sensory loss and reduced DTRs. EMG shows small motor unit action potentials. What is your diagnosis?
This patient has muscular dystrophy. Note that the hands and feet are spared which is typical of muscular disorders.
