Intro to Neurology

Question 1

Frontal Lobe

Answer 1

• Motor
• Motor Suppressor
• Personality
• Memory
• Impulse control
• Olfaction
• Language

Question 2

Broca’s Aphasia

Answer 2

Broken Speech; still follows a pattern

Question 3

Wernicke’s Aphasia

Answer 3

Very wordy; the words do not make any sense

Question 4

Temporal Lobe

Answer 4

• Auditory Sense
• Language Sense
• Visual Associations (Meyer’s loop)
• Memory
• Emotions
• • Seizure foci live here (grand mal seizure activity)

Question 5

Parietal Lobe

Answer 5

• Sensory (pain and touch)
• Cognition; information processing
• Spatial Orientation; visual perception
• Speech (Wernicke’s area)

Question 6

Occipital Lobe

Answer 6

• Visual Sense

Question 7

Limbic Lobe

Answer 7

• Thalamus
• Hypothalamus
• Hippocampus
• Amygdala
• Emotions
• Memory

Question 8

Cerebellum

Answer 8

• Coordination
• Balance
• Equilibrium
• Muscle Tone
• • Remember specialized cerebellar tests

Question 9

Cerebellar Tests

Answer 9

1. Diadochokinesia (RAM): flipping hands up and down, tests ataxia
2. Toe Tapping
3. Finger to nose
4. Heel to shin: heel to opposite knee and slide it down, tests walking ability
5. Rhomberg: close eyes, put arms out
6. Pronator drift: hands face up and close eyes

Question 10

A lesion of the motor cortex on one side is more likely to result in?

Answer 10

Hemipariesis

Question 11

A lesion of the spinal cord (transection) is more likely to result in?

Answer 11

Paraplegia

Question 12

Skull X-Ray

Answer 12

• Not useful at looking at brain tissue
• Can identify: sinusitis, intrinsic bone lesions, skull fx and FB
• No bleeding or edema

Question 13

Head CT

Answer 13

• If a hemorrhage is suspected NO CONTRAST
• Ischemic stroke will not show up right away, have to wait 7 days
• CT with contrast for neoplasms
• CT myelogram if MRI not possible
• CT for acute problems, MRI for chronic problems

Question 14

MRI (5)

Answer 14

• Protons align in the bodies tissues when exposed to strong magnetic fields
• Combined with radiofrequency, which causes protons to vibrate
• T1 density weighted, Spin density weighted, T2 density weighted
• Sections are big/far apart
• Gadolinium is the contrast used for tumors

Question 15

Advantages of MRI (5)

Answer 15

• No ionizing radiation
• Better resolution between gray and white matter and of soft tissues
• Better at seeing smaller lesions/infarcts and find them sooner than CT
• Scan of choice for midbrain, pons, and medulla lesions
• Diagnosis MS

Question 16

Problems with MRI (9)

Answer 16

• Expensive
• In acute hemorrhage, blood is difficult to distinguish from other structures
• Claustrophobic
• Difficult if pt needs to be monitored
• Some its don’t fit
• Cant do if pt has metal in them
• Slow
• Movement artifact
• Loud noises

Question 17

Surgical MRI (3)

Answer 17

• Open MRI
• Surgery is done during scanning
• More accurate, smaller incisions, better margins

Question 18

Magnetic Resonance Angiogram (MRA) (3)

Answer 18

• Good at detecting lesion in vasculature of the head
• Good for AVM’s, aneurysm, venous abnormalities, stroke, TIA
• Bad for torturous vessels

Question 19

Cerebral Angiogram (3)

Answer 19

• Contrast is injected
• Good for AVM’s, aneurysms, carotid artery stenosis
• Complications: hematoma, dislodging plaques, forming fistulas etc….

Question 20

Positron Emission Tomography (PET) (4)

Answer 20

• Blood Flow
• Glucose utilization
• Limited for diagnostic purposes
• Useful to see hyper function dz in the brain and where brain loss has occurred

Question 21

Single-positron emission computerized tomography (SPECT) (2)

Answer 21

• Good to see blood flow in dementia, trauma, CVD

- Can distinguish tumor recurrence from radiation induced necrosis

Question 22

Electromyography(EMG) (3)

Answer 22

• Electrodes placed over muscles or nerves
• electrical current administered
• waveforms are measured and compared to the other side

Question 23

Nerve conduction studies (NCS) (3)

Answer 23

• Needles inserted into muscles or nerves
• Only measures large sensory nerves
• Differentiates btw axonal loss from demyelinating process and quantify the loss and chronic from acute etc…

Question 24

Myelogram (2)

Answer 24

• Contrast in intrathecal space and observed under fluoroscopy
• Identifies cord compression

Question 25

Nerve and Muscle Biopsies (2)

Answer 25

- Can help diagnose inflammatory, demyelinative or infiltrative neuropathies of PNS - Take part of the nerve or muscle under general anesthesia

Question 26

Electroencephalography (EEG) (4)

Answer 26

- Brain emits very low voltage electricity - Localizes where the seizure is coming from with epileptiform spikes - Focal lesion: cause only a few leads to change - Generalized: causes all leads to change

Question 27

Evoked Potentials (3)

Answer 27

- Detect abnormalities in the CNS - Defines distribution of disease and monitors change - Evaluates vision and hearing in children

Question 28

3 Types of Evoked Potentials

Answer 28

- Pattern shift visuals evoked potentials (PSVEP) - Brainstem auditory evoked responses (BAER) - Somatosensory evoked responses (SSER)

Question 29

Brain Biopsy (2)

Answer 29

- Consider when other tests are inconclusive | - Stereotactic biopsies can leave scars and cause seizures

Question 30

What do you do to test CSF? (2)

Answer 30

- LP used to test for: | - MS, pseudotumor cerebri, meningitis/CNS infections etc…..