Neurology

Question 1

Associated Effects of lesion in Anterior cerebral artery?

Answer 1

Contralateral hemiparesis and sensory loss, lower extremity > upper

Question 2

Associated Effects of lesion in Middle cerebral artery?

Answer 2

Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia

Question 3

Associated Effects of lesion in Posterior cerebral artery?

Answer 3

Contralateral homonymous hemianopia with macular sparing
Visual agnosia

Question 4

Associated Effects of lesion in Weber’s Syndrome (branches of the posterior cerebral artery that supply the midbrain)?

Answer 4

Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity

Question 5

Associated Effects of lesion in Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)

Answer 5

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

Question 6

Associated Effects of lesion in Anterior inferior cerebellar artery (lateral pontine syndrome)?

Answer 6

Symptoms are similar to Wallenberg’s (see above), but:
Ipsilateral: facial paralysis and deafness?

Question 7

Associated Effects of lesion in Retinal/ophthalmic artery?

Answer 7

Amaurosis Fugax- painless black curtain coming down vertically into the field of vision in one eye.
- It might be permanent or transient, depending on the aetiology.
- It is due to hypoperfusion of the retinal artery due to an obstruction.
- As it supplied the optic nerve directly behind the eye, it will cause ipsilateral disease

Question 8

Associated Effects of lesion in Basilar Artery?

Answer 8

Locked-in Syndrome

Question 9

Rotavirus Vaccine

Answer 9

• Oral live attenuated vaccine
• 2 doses. 1st at 2 months and 2nd at 3 months.

Question 10

Frontal Lobe Seizure

Answer 10

Head/leg movements, posturing, post-ictal weakness,
Jacksonian march (progression of muscle contractions from distal to proximal on the ipsilateral side).

Question 11

Temporal Lobe Seizure

Answer 11

May occur with or without impairment of consciousness or awareness

An aura occurs in most patients
typically a rising epigastric sensation
also psychic or experiential phenomena, such as déjà vu, jamais vu
less commonly hallucinations (auditory/gustatory/olfactory)

Seizures typically last around one minute
automatisms (e.g. lip smacking/grabbing/plucking) are common

Post-ictal dysphagia and lip smacking? Think Temporal!

Question 12

Parietal Lobe Seizure

Answer 12

Altered sensation on the contralateral side. This can be paraesthesia, loss of temperature and/or pain sensation and tingling.

Question 13

Occipital Lobe Seizure

Answer 13

Can cause positive or negative phenomena.
Positive phenomena are things like flashes and floaters, while negative phenomena can be loss of areas of the visual field.

Question 14

Absolute Contraindications to thrombolysis for stroke

Answer 14

• Previous intracranial haemorrhage
• Seizure at onset of stroke
• Intracranial neoplasm
• Suspected subarachnoid haemorrhage
• Stroke or traumatic brain injury in preceding 3 months
• Lumbar puncture in preceding 7 days
• Gastrointestinal haemorrhage in preceding 3 weeks
• Active bleeding
• Pregnancy
• Oesophageal varices
• Uncontrolled hypertension >200/120mmHg

Question 15

Relative Contraindications to thrombolysis for stroke

Answer 15

• Concurrent anticoagulation (INR >1.7)
• Haemorrhagic diathesis
• Active diabetic haemorrhagic retinopathy
• Suspected intracardiac thrombus
• Major surgery / trauma in the preceding 2 weeks

Question 16

Uhthoff’s Phenomenon

Answer 16

Neurological symptoms exacerbated during a rise in temperature such as taking a hot shower/bath or exercising. Often affecting the eyes of MS patients

Question 17

Lhermitte’s sign

Answer 17

Paraesthesiae in limbs on neck flexion

Question 18

McArdle’s Sign

Answer 18

Transient exacerbation of weakness following greater than 10% neck flexion seen in some MS patients. Rapid, reversible weakness

Question 19

Wernicke’s aphasia

Answer 19

Receptive aphasia
Lesion in the superior temporal gyrus which is supplied by the inferior division of the left MCA.
Speech ‘forms’ in Wernicke’s area before ‘sending’ it to Broca’s area.
‘Word salad’ speech makes no sense but is fluent.
Impaired comprehension

Question 20

Broca’s Aphasia

Answer 20

Expressive aphasia
Lesion of the inferior frontal gyrus. It is typically supplied by the superior division of the left MCA
Speech is non-fluent, laboured, and halting. Repetition is impaired
Comprehension is normal

Question 21

Conduction Aphasia

Answer 21

Classically due to a stroke affecting the arcuate fasiculus - the connection between Wernicke’s and Broca’s area

Speech is fluent but repetition is poor. Aware of the errors they are making

Comprehension is normal

Question 22

Global Aphasia

Answer 22

Large lesion affecting all 3 of the above areas resulting in severe expressive and receptive aphasia

May still be able to communicate using gestures