Neurology

Question 1

Anterior cerebral artery stroke presentation

Answer 1

• Paralysis & sensory loss of contralateral LE
• Impaired gain and stance
• Abulia (slowness/prolonged delays performing acts)
• Flat affect, lack of spontaneity, slowness & distractability
• Cognitive impairment
• Urinary incontinence

Question 2

Middle cerebral artery stroke symptoms

Answer 2

• Contralateral hemiparesis (arm and leg) & sensory loss
• Aphasia (if dominant lobe)
• Facial droop

Question 3

What is internuclear opthalmoplegia, where does it localize and what does it suggest?

Answer 3

• bilateral horizontal diplopia 2/2 weak adduction on lateral gaze
• medial longitudinal fasciculus (MLF)
• most common etiologies are MS and cerebrovascular disease (also may occur with Wernicke encephalopathy & gliomas)

Question 4

Amyotrophic Lateral Sclerosis pathophysiology, presentation & prognosis

Answer 4

• pathophysiology: motor neuron degeneration & death with gliosis replacing lost neurons (anterior horn cells)
• presentation: hyperreflexia, spasticity, +Babinski (upper motor neurons); muscle fasciculations, atrophy, muscle cramps, asymmetric distal weakness WITHOUT sensory findings (lower motor neurons)
• prognosis: median survival 3-5 years

Question 5

Vitamin B12 (cobalamin) deficiency presentation

Answer 5

• psych: depression, irritability, psychosis
• heme: anemia (megaloblastic)
• neuro: sensory & motor deficits (areflexia, paresthesias), dementia
• GI: N/V/D

Question 6

Acute dystonic reaction cause, presentation & management

Answer 6

• cause: antipsychotics or antidopaminergic drugs
• pres: muscle spasms (e.g., torticollis) & stiffness
• mgmt: benztropine, diphenhydramine