neuro formative Flashcards
which spinal tract is responsible for exciting felxor muscles + inihibiting extensor muscles of the upper body
rubrospinal tract
how would cervical myelopathy present
symmetrical weakness of legs, mild weakness of hands, abnormal gait
reflexes extrememly brisk in legs with upgoing planters bilaterally
(cervical herniation does not always cause cervical myelopathy)
A 45 year old call centre worker is complaining of lumbar pain for the past two months. He gets stiffness in the morning and the pain gets worse on prolonged sitting and turning over in bed.
mechanical back pain
(NOT disc herniation lol obvs idiot)
which vein can rupture between the dura + arachnoid
bridging vein
between what layers does the posterior communicating artery anneurysm lie
between arachnoid + pia
An 80-year-old ex-smoker with uncontrolled hypertension presented with the acute onset of numbness of his left arm and leg. On examination, there was decreased sensation to all his left side of the body and face. what type of stroke?
lucunar
A 66-year-old female with atrial fibrillation presents with dysphasia and left hemiparesis. what type of stroke
partial anterior circulation infarct
A 70-year-old male with left homonymous hemianopia. He has no other symptoms. what type of stroke
posterior circulation infarct
Choose the investigation that would provide the definitive diagnosis:
A 70 year old patient presents with progressive headaches and nausea with gradual loss of sensation in her right arm. Imaging reveals a mass in the temporal lobe
biopsy
A 25-year-old man developed a sudden onset ‘worst ever’ headache and collapsed - IX for definitive diagnosis
CTA
–> berry aneurysm causing SAH
where is primary auditory cortex
superior temporal gyrus
where is the oculomotor nucleus
midbrain
According to the patient’s symptoms, where is the most probable location of these brain tumours:
- A 7 year old boy presents with progressive headache, wide based ataxia and difficulty speaking. Imaging and biopsy confirms the presence of a pilocytic astrocytoma.
cerebellum
According to the patient’s symptoms, where is the most probable location of these brain tumours:
A 56-year-old man presented to the hospital with a seizure. He had been complaining of headaches for the past several months and has been “bumping into things”. On examination, it was revealed that he has a left superior quadrantopia. Imaging and biopsy confirmed a Glioblastoma multiforme.
right temporal lobe
According to the patient’s symptoms, where is the most probable location of these brain tumours:
A 40 year old right-handed accountant presents with difficulty in writing and that he “wasn’t as good with numbers as before”. On examination, he had a left-right disorientation. Imaging and biopsy confirmed the presence of a meningioma.
left parietal lobe
(left dominant lobe if right handed)
Which one of the following is NHS standard of care for a symptomatic, easily accessible glioblastoma in a young, fit patient?
Maximal surgical debulking surgery
Temozolomide chemotherapy
Radiotherapy
A 25-year-old man developed a severe headache and collapsed. Upon calling his name, he does not respond nor opens his eyes. However, when a painful stimulus is applied he internally rotates his shoulders and flexes his forearm and wrists while extending his legs. GCS?
5
A 70-year-old woman presents with a headache and confusion, 4 weeks after she suffered from a fall. She opens her eyes spontaneously and moves her arms and legs when told to. GCS?
14
A 20-year-old male presented to A&E after being in a car accident. Neurologic evaluation was as follows: he opened his eyes only to the sound of his name, he was able to localize to a painful stimulus but failed to move his arms and legs to command only. When asked where he was his reply was “my house to go”
GCS?
11
A patient presents with unilateral pupil mydriasis that does not constrict to light following a car accident. On CT, an intracranial haemorrhage was identified. What is the most likely type of herniation?
uncal herniation
What is the cause for this patient’s sensation and motor weakness:
A 39-year-old woman presented with severe headaches whenever she sneezed. She also had decreased sensation to pinprick over her upper back, shoulders, and upper arms. Her power in her arms was 2/5 but her lower body power was 5/5.
syringomyelia
(cape-like distribution)
What is the most likely cause of this patient’s symptoms:
A 6-month-old girl presented with a head circumference rising from the 66th to the 99th percentile and failure to thrive. On examination, when the lids are retracted, the eyes look like they are sunsetting, and upward gaze is impaired.
non-communicating hydrocephalus due to aqueduct stenosis
Choose the correct anatomical area that correlates to the following functions:
1. A 56-year-old man presents with a headache, severity 8/10 with associated nausea. On examination he has ptosis, and miosis.
internal carotid artery dissection
Choose the correct anatomical area that correlates to the following functions:
- A 56-year-old man presents with a progressive headache, severity 6/10 with associated nausea. On examination he has ptosis, and a right dilated unreactive eye.
Posterior communicating artery aneurysm
(oculomotor nerve travels directly from the brainstem to the eye in a straight line. It travels through the cavernous sinus and close to the posterior communicating artery)
closed angle gluc would probs be more sore
What is the most likely diagnosis in the following cases:
- A 40-year-old obese lady on the contraceptive pill develops headaches first thing in the morning which are worse on coughing. She is complaining of double vision. What could be causing her diplopia?
CN VI palsy
most common causes of sixth nerve palsy are high blood pressure, diabetes, TIA (transient ischemic attack/mini stroke) or stroke.
What is the most likely diagnosis in the following cases:
- A 55 year old man develops diplopia after a closed head injury accident. He says the diplopia is worse when he is going down the stairs. On examination, you see he has a head tilt to the right.
CN IV
worse going down stairs **
A 30-year-old female presented with double vision and ataxia. Three years earlier she had an episode where she lost vision in her left eye for two weeks. On exam, she was mildly ataxic, with brisk reflexes, and both horizontal and vertical nystagmus. What is the most likely diagnosis?
multiple sclerosis
holmes adie pupil
unilateral dilated pupil that is sluggish to react to light with slow dilation of the pupil following constriction
caused by damage to post-ganglionic parasympathetic fibres
holmes adie syndrome = pupil + absent ankle + knee reflexes
argyll-robertson pupil
specific finding in neurosyphilis
- a constricted pupil that accomodates when focusing on a near object but DOES not react to light
(prostitutes - it accommodates but does not react)
