Intro to Neurology (Adams)

Question 1

A 70 yo right handed man has aphasia and right hemiparesis for the last 2 hours. He has a past history of atrial fibrillation. Where and what is the lesion, and how could it have occured?

Answer 1

Where: Left cerebral hemisphere, causing right hemiparesis with language difficulty (think of Broca’s area on the left)

What: 2 hours is consistent with an acute event like stroke

How: With past hx of afib, think embolus

Question 2

Acalculia is associated with lesions of the parietal and frontal lobes and results in difficulties with performing simple mathematics. Which hemisphere is usually affected?

Answer 2

Left side (dominant hemisphere in most people)

Question 3

Hemispatial neglect results most commonly from brain injury to the _____ cerebral hemisphere, causing visual neglect of the _____-hand side of space.

Answer 3

right cerebral hemisphere; left-hand (nondominant for most) side of space

*2 other conditions associated with damage to the right side hemisphere include:

• Anosognosia (lack of knowledge of illness)
• Asomatognosia (lack of knowledge of body part)

Question 4

weakness, hyperreflexia, spasticity, and Babinski sign are indicators of what type of lesion?

Answer 4

upper motor neuron

Question 5

weakness, hyporeflexia, flaccidity, atrophy, and fasciculations are all symptoms that are typical of what kind of lesion?

Answer 5

lower motor neuron

*fasciculation - spontaneous contraction affecting a small number of muscle fibers, often causing a flicker of movement under the skin

Question 6

if there is no facial involvement, where is the lesion?

Answer 6

low brainstem or spinal cord

Question 7

paraparesis - involvement of both legs with arms normal - is indicative of a leison where?

Answer 7

spinal cord

Question 8

hemiparesis indicates a lesion where?

Answer 8

contralateral brain stem or cerebral hemisphere

Question 9

True or False: visual loss almost always involves a brainstem lesion.

Answer 9

False. You cannot have visual loss with a brainstem lesion, as lesions must involve the optic nerve, chiasm, tract or cerebral hemisphere - all of which reside above the infratentorium.

Question 10

what is dissociated sensory loss?

Answer 10

it’s the term used to describe the pattern of selective modality loss with any given lesion - this is due to 2 sensory systems that send information up to the cortex: the spinothalamic, which relays pain and temperature sensation, and the dorsal columns, which conduct vibratory and position sense.

Question 11

though incoordination/ataxia may result from motor or sensory impairments, lesions of what structure typically result in these deficits?

Answer 11

cerebellum

Question 12

Which of the following is a distinct symptom that differentiates lesions in the dominant (vs. non-dominant) cerebral cortex?

A. Contralateral hemiparesis

B. Contralateral hemi-sensory loss

C. Contralateral visual field loss

D. Mild dysarythria

E. Aphasia

Answer 12

E. All of these signs are attributable to lestions in dominant and non-dominant hemisphere except aphasia. This is characteristic of a dominant lesion hemisphere.

Question 13

Which of the following is a characteristic symptom of non-dominant cerebral cortex lesion?

A. Apraxia

B. Aphasia

C. Aprosody

D. Acalculia

E. Alexia

Answer 13

Aprosody (lack of variations in normal speech characteristics) is due to a lestion in the non-dominant hemisphere.

*others include:

• anosognosia - deficit of self-awareness
• asomatognosia - loss of recognition or awareness of part of the body
• contralateral hemi-spatial neglect

Question 14

contralateral sensory loss with or without weakness is the most common pattern of signs for lesions of what structure?

Answer 14

thalamus

*other signs include

• abnormal ocular motility (vertical gaze)
• disturbed consciousness/sleep-wake cycle
• behavioral or cognitive impairments

Question 15

isolated cranial nerve III palsy is most likely due to a lesion inside or outside the CNS?

Answer 15

outside. if it were in the brainstem there would be other symptoms to help with the diagnosis.

Question 16

name two examples of cranial nerve mononeuropathy in which there would be sensory/motor loss on the affected side

Answer 16

Bell’s palsy (VII)

Trigeminal neuralgia (V)

Question 17

features of this type of lesion include diplopia, incoordination, tremor, waxing-and-waning consciousness, weakness and numbness

Answer 17

midbrain lesion

*much less common than medullary or pontine lesions

Question 18

what are the 2 major signs associated with midbrain lesions?

Answer 18

• CN III and IV palsies
• Internuclear ophthalmoplegia - disorder of conjugate lateral gaze in which the affected eye shows impairment of adduction

Question 19

features of these types of lesions may be bilateral or unilateral, and include coma, weakness of all limbs (when involvement is bilateral), dysphagia, dysarthria, diplopia (when involvement is unilateral)

Answer 19

pontine lesions

Question 20

clinical signs of lesions in this area include:

• ipsilateral signs of ataxia, nystagmus, facial sensory loss, and CN XII dysunfction
• contralateral signs of limb sensory loss and hemiparesis

Answer 20

medulla

Question 21

which of the following cerebellar locations: lesion signs is incorrectly matched?

A. Floccular-nodular: visual defecits

B. Vermis-paravermian: truncal ataxia

C. Hemisphere: vestibular deficits

D. pan-cerebellar: all signs above

Answer 21

C. Vestibular defecits go with floccular-nodular lesions. Cerebellar hemisphere lesions can produce classic ipsilateral limb ataxia (intention tremor, past pointing and mild hypotonia).

Question 22

clinical features of this spectrum of diseases reflect the function of the spinal cord: abnormal gait, dermatomal sensory loss, motor problems (including +Romberg sign), weak rectal sphincter and orthostatic hypotension

Answer 22

myelopathies

Question 23

progressive weakness of the limbs with no autonomic or sensory symptoms, possibly with fasciculations in “asymptomatic” areas are findings of what group of diseases?

Answer 23

neuronopathies (ie, ALS)

Question 24

neck and back pain with pain, paresthesia, numbness and weakness that refers to limbs in a dermatomal pattern is characteristic of what group of diseases?

Answer 24

radiculopathies

*may be caused by herniated disk, injury or tumor at the level of the nerve root after it leaves the spinal cord.

Question 25

group of diseases that are most commonly isolated to the lumbosacral and brachial regions of the spine and may be caused by an injury, cancer, radiation therapy or vascular disease

Answer 25

plexopathies

Question 26

plexopathy that affects the upper brachial plexus with pain, weakness and sensory loss primarily at the shoulder

Answer 26

Erb palsy

Question 27

plexopathy that affects the lower brachial plexus with pain, weakness and sensory loss primarily at the wrist and hand

Answer 27

Klumpke palsy

Question 28

most mononeuropathy is due to _____ at a site of nerve vulnerability (ie, close to the surface, tight compartment, bone)

Answer 28

trauma

Question 29

Which of these would not be considered a nerve that is at a site of nerve vulnerability?

A. Median nerve

B. Ulnar nerve

C. Femoral nerve

D. Peroneal nerve

E. Vagus nerve

Answer 29

E.

Question 30

involvement of multiple individual nerves usually, in the face and limbs, and is seen in inflammatory diseases like vasculitis, leprosy, and diabetes

Answer 30

mononeuropathy multiplex

Question 31

toxic process that involves the long nerves with distal findings being the most prominent

Answer 31

polyneuropathy

Question 32

myasthenia gravis and organophosphate poisoning are examples of this group of diseases, which result in fatigue and weakness that worsens with activity, medications or concomitant illness; proximal neck/muscle weakness that may lead to respiratory distress

Answer 32

neuromuscular junction diseases

Question 33

broad category of diseases that displays bilateral weakness that is usually worse in shoulders and hips, making it hard to walk, climb stairs or get up from a chair

Answer 33

muscle diseases (ie, myopathy, muscular dystrophy, polymyositis)

*clinical presentation may show trendelenburg sign and waddling gait

Question 34

upper motor neuron signs are found with lesions affecting the _______ tract, and depending on location/severity, the patterns of weakness are hemiparesis, paraparesis and _________.

Answer 34

corticospinal; quadriparesis

Question 35

In which of following locations would you NOT expect to find a lesion that will cause dysarthria?

A. Cerebral hemisphere

B. Brainstem

C. Cerebellum

D. Thalamus

E. Neuromuscular junction

Answer 35

Thalamus

Question 36

True or False: In patients with primary muscle diseases, proximal muscles are generally more severely affected than distal muscles.

Answer 36

True