neuro lesions

Question 1

subacture combined degenration of spinal chord?

Answer 1

Bilateral spastic paresis and loss of fine touch, proprioception.
UMN SX: loss of ankle jerk, brisk knee reflexes, extensor plantar, muscle wasting,
CX: b12

Question 2

Anterior spinal A occlusion SX?

Answer 2

Bilateral spastic paresis (lateral cortciospinal), loss of pain and temp sensation (lateral spinothalamic)

Question 3

Freidrich’s ataxia?

Answer 3

Bilateral spastic paresis and loss of fine touch, proprioception. and cerebellar sx - ataxia

Question 4

MCA occlusion Sx?

Answer 4

upper limb sens more than lower limb sens loss
hemianopia, 
wernicke's
facial droop
dysphagia

Question 5

ACA occlusion?

Answer 5

legs sensation loss more than upper limbs. broca’s aphasia, personality/behaviour change

Question 6

Frontal lobe SX?

Answer 6

Broca’s personality, inhibition, incontinuence, gait, anosmia

Question 7

parietal lobe SX?

Answer 7

somatosensory loss, writing maths, cant draw clock, inferior quadrantopia, finger agnosia, apraxia,

Question 8

temporal lobe SX?

Answer 8

wernicke’s aphasia, sup quadrantopia, like foreign language, cant recognise facial expressions,

Question 9

occipital lobe SX?

Answer 9

visual agnosia, HH - macula sparing, cortical blindness,

Question 10

cerebellar hemisphere vs vermis sx?

Answer 10

hemisphere: peripheral ataxia
vermis: gait affected

Question 11

a teenage boy presents with clumsy walking. On examination he has gait ataxia, an intention tremor and loss of lower limb reflexes

Answer 11

friedreich’s ataxia

Question 12

a 25-year-old man with muscle weakness is reviewed in clinic. On shaking his hand he has difficultly loosening his grip. On examination he has frontal balding, bilateral ptosis and cataracts

Answer 12

Myotonic dystrophy

Question 13

tuberous sclerosis features

Answer 13

Cutaneous features
depigmented ‘ash-leaf’ spots which fluoresce under UV light
roughened patches of skin over lumbar spine (Shagreen patches)
adenoma sebaceum (angiofibromas): butterfly distribution over nose
fibromata beneath nails (subungual fibromata)
café-au-lait spots* may be seen

Neurological features
developmental delay
epilepsy (infantile spasms or partial)
intellectual impairment

Also
retinal hamartomas: dense white areas on retina (phakomata)
rhabdomyomas of the heart
gliomatous changes can occur in the brain lesions
polycystic kidneys, renal angiomyolipomata
lymphangioleiomyomatosis: multiple lung cysts

Question 14

Syringomyelia SX?

Answer 14

1. Flacid paresis (typically affecting the intrinsic hand muscles)
2. Loss of pain and temperature sensation

Question 15

Neurosyphilis (tabes dorsalis) SX?

Answer 15

1. Loss of proprioception and vibration sensation. no motor loss.

Question 16

Meralgia paraesthetica sX?

Answer 16

lateral femoral cutaneous nerve (LFCN) - Symptoms may be reproduced by deep palpation just below the ASIS (pelvic compression) and also by extension of the hip.
There is altered sensation over the upper lateral aspect of the thigh.
There is no motor weakness.

Question 17

Posterior cerebral artery SX?

Answer 17

Contralateral homonymous hemianopia with macular sparing

Visual agnosia

Question 18

Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain)

Answer 18

Ipsilateral CN III palsy

Contralateral weakness of upper and lower extremity

Question 19

Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome) SX?

Answer 19

Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

Question 20

Anterior inferior cerebellar artery (lateral pontine syndrome) SX?

Answer 20

Ipsilateral: facial paralysis and deafness

Question 21

Basilar artery SX?

Answer 21

locked in syndrome

Question 22

Lacunar strokes SX?

Answer 22

present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
strong association with hypertension
common sites include the basal ganglia, thalamus and internal capsule

Question 23

Cranial DI Cx?

Answer 23

• idiopathic
• post head injury
• pituitary surgery
• craniopharyngiomas
• histiocytosis X
• DIDMOAD is the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram's syndrome)
haemochromatosis

Question 24

DIDMOD stands for?

Answer 24

• DIDMOAD is the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram’s syndrome)

Question 25

brocas area region?

Answer 25

Due to a lesion of the inferior frontal gyrus. It is typically supplied by the superior division of the left MCA

Question 26

wernicke’s aphasia area?

Answer 26

(receptive) aphasia Due to a lesion of the superior temporal gyrus. It is typically supplied by the inferior division of the left MCA

Question 27

wrist drop
sensory loss to small area between the dorsal aspect of the 1st and 2nd metacarpals
paralysis of triceps

Answer 27

radial N lesion
This man has ‘Saturday night palsy’ caused by compression of the radial nerve against the humeral shaft, possibly due to sleeping on a hard chair with his hand draped over the back

Question 28

CX of CN3 palsy

Answer 28

diabetes mellitus
vasculitis e.g. temporal arteritis, SLE
false localizing sign* due to uncal herniation through tentorium if raised ICP
posterior communicating artery aneurysm
pupil dilated
often associated pain
cavernous sinus thrombosis
Weber’s syndrome: ipsilateral third nerve palsy with contralateral hemiplegia -caused by midbrain strokes
other possible causes: amyloid, multiple sclerosis

Question 29

drugs that worsen MG?

Answer 29

penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines

Question 30

Most common type of brain tumour?

Answer 30

glioblastoma multiforme