Introduction to clinical neurology

Question 1

What are the key areas and their functions in the frontal lobe of the brain?

Answer 1

Pre central gyrus (motor cortex)- motor function of the opposite side of the body
Broca’s area (inferior frontal gyrus) - controls the speech output (dominant hemisphere)
emotions

Question 2

What are the key areas and their functions in the parietal lobe of the brain?

Answer 2

Postcentral gyrus (sensory cortex)= sensory function of the opposite side of the body

Question 3

What are the key areas and their functions in the temporal lobe of the brain?

Answer 3

Memory

Dominant hemisphere contains the wernicke’s area (superior temporal gyrus) = controls the comprehension of speech

Question 4

What are the key areas and their functions in the occipital lobe of the brain?

Answer 4

control vision

Question 5

Why is identifying cranial nerve abnormalities important?

Answer 5

helps to localize the area of the brain that’s affected

Question 6

What level of the vertebrae does the spinal cord end?

Answer 6

L1

Question 7

What are the different types of localization?

Answer 7

Focal = single, discrete neuroanatomical locus can account for all the patient’s symptoms and signs (stroke)

Multifocal = involves more than one locus but the loci remain discrete (MS)

Diffuse = widespread dysfunction of a part of the nervous system (encephalopathy)

Specific pattern (PD)

Question 8

What does the posterior (dorsal) root allow?

Answer 8

motor neurones to enter the spinal cord (sensory)

Question 9

What does the anterior (ventral) root allow?

Answer 9

motor neurones to exit the spinal cord (motor)

Question 10

What are the upper motor neuron signs?

Answer 10

increased tone (spasticity)
weakness with no wasting
brisk reflexes and clonus
upgoing planters

Question 11

What are the lower motor neurons signs?

Answer 11

reduced tone
weakness, wasting ad fasciculations
reduced or absent reflexes
downgoing (normal) plantars

Question 12

What are the motor and sensory spinal tracts?

Answer 12

sensory = spinothalamic (pain and temperature- course touch) and dorsal column tracts (position and vibration - fine touch) 
motor= corticospinal

Question 13

What is the dermatome for the biceps, supinator, triceps, knee and ankle reflexes?

Answer 13

Biceps - C5
Supinator - C6 
Triceps - C7
Knee - L4 
Ankle - S1

Question 14

Define:

• acute
• subacute
• recurrent-remittent
• chronic progressive

Answer 14

acute= minutes to hours
subacute= days to weeks
recurrent-remittent = episodic attacks of symptoms with a degree of recovery 
chronic-progressive= months to years

Question 15

What are some examples of paroxysmal disorders?

Answer 15

headaches and facial pain
seizure and syncope
TIA
vestibular disorders

Question 16

What are negative symptoms?

Answer 16

implies at least partial or complete failure of impulse conduction in a functional system

• reduction (weakness, numbness)
• complete loss of function (paralysis)

Question 17

What are positive symptoms?

Answer 17

exaggeration of a physiological phenomenon

• brief and very intense (seizures)
• episodic and recurrent (trigeminal neuralgia)
• slow and continuous (tremor)

Question 18

What are secondary symptoms?

Answer 18

symptoms referable to “mass effect”

- lesion (tumor) causes primary symptoms by local destruction and secondary symptoms as the lesion grows

Question 19

What are behavioral symptoms?

Answer 19

complex changes in personality and behavior

Question 20

What are the different neuroradiological investigations ?

Answer 20

CT, CTA (angiogram), CTV (venogram)
MRI, MRA, MRV
Angiography

Question 21

What are the different neurohysiological investigations ?

Answer 21

EEG

EMG/NCS

Question 22

Other than neuroradiological and neurophysiological investigations what other near investigations are there ?

Answer 22

LP/CSF
Genetics
Immunology - for myasthenia gravis - look for Ab

Question 23

What are the benefits and disadvantages of CTs?

Answer 23

easily available
commonly used in emergency
useful in detecting an intracranial bleed and abnormalities in intracranial blood vessels

radiation
not helpful in detecting demyelinating plaques or spinal cord pathology

Question 24

What are the benefits and disadvantages of MRI?

Answer 24

no radiation
detecting various brain and SC pathology
demonstrates abnormalities in intracranial blood vessels

claustrophobic
can not be used in patients with metallic foreign bodies e.g. pacemakers

Question 25

What is the gold standard for imaging intracranial blood vessels?

Answer 25

angiography - treatment tool in coiling aneurysms

Question 26

What do EEGs do?

Answer 26

routine sleep EEG, ambulatory and video telemetry
epilepsy

measure the neuronal activity in the brain

Question 27

How NCS (nerve conduction study work?

Answer 27

by electrical stimulation of peripheral nerves - measure both sensory and motor function
Assessment of peripheral neuropathy and diagnosing entrapment

Question 28

What is EMG (electromyography)?

Answer 28

fine needle inserted directly into the muscle to look for spontaneous activity and motor unit potential
assessment of peripheral neuropathy
assessment of neuromuscular disorders (MG)
demonstrating fibrillation potentials (MND)

Question 29

When is an LP indicated?

Answer 29

acute headache or patients with a possible diagnosis of meningitis or encephalitis
possible (MS) or any other inflammatory CNS disorder

Question 30

When are LPs contraindicated?

Answer 30

in patients with symptoms or signs attributable to raised intracranial pressure as this could lead to tentorial herniation and coning

Question 31

What is CSF analyses for?

Answer 31

protein, cells and glucose
use spectrophotometry to look for blood break down products (subarachnoid hemorrhage)
oligoclonal bands is used to help to diagnose MS

Question 32

Why do you get a post LP headache?

Answer 32

results from reduction in intracranial pressure
headache is wore on sitting to standing
usually resolves spontaneously within 7-10 days