Neurology Flashcards by sara ashurst

*60 y/o right-handed M, getting lost, only writes on right half of paper. Left-sided hemi-neglect. Where is the lesion? (8x)

RIGHT PARIETAL LOBE

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*66 y/o c/o frequent falls, several-month hx of anxiety, unwillingness to leave home. On exam, mild impairment of vertical gaze on smooth pursuit/ saccades, mild axial rigidity & minimal rigidity of upper extremities, along w mild slowness of movement on finger tapping, hand opening & wrist opposition. Posture nml. Gait tentative/awkward, but w/o shuffling, ataxia, tremor. Pt is slow in arising from a chair. Most likely dx: (5x)

PROGRESSIVE SUPRANUCLEAR PALSY

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*65 y/o pt fell several times past 6 mos. MSE nml. Smooth pursuit, saccadic movements impaired. Worse w vertical gaze. Full ROM w doll head maneuver. Mild symmetric rigidity/bradykinesia, no tremor. MRI/CSF/labs unremarkable. Dx? (4x)

PROGRESSIVE SUPRANUCLEAR PALSY

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*26 y/o w HA, clumsiness of right hand x weeks. Struggles w rapid alternating movements of R hand, overt intention tremor w finger-to-nose, mildly dysmetric finger-tapping. CNs nml, no papilledema. Damage to what is seen on MRI? (3x)

CEREBELLUM

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*9 y/o F has 3 month h/o seemingly unprovoked bouts of laughter. Worse when not sleeping well. Pt does not feel happy during these episodes. Started menstruating 6 months ago, and at Tanner stage 4. Dx? (2x)

HYPOTHALAMIC HAMARTOMA

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*5 y/o with 4 month history of morning HA, vomiting, and recent problems with gait, falls, and diplopia: (2x)

MEDULLOBLASTOMA

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70 y/o pt develops confusion, lethargy, and generalized tonic-clonic seizure. Lab reveals serum sodium of 95mEq/L. This is most likely a complication of excessively rapid correction of which metabolic problem?

CENTRAL PONTINE MYELINOLYSIS

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*Visual problem in pituitary tumor compressing optic chiasm (10x)

BITEMPORAL HEMIANOPSIA

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Rasmussens encephalitis - assoc Ab?

Rasmussen’s encephalitis is a rare progressive inflammatory condition that usually affects one side of the cerebrum. Autoantibodies against the Glu3 receptor have been reported.

THIS IS HIGH YIELD FOR THE RITE.

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Memory loss pattern in dissociative amnesia

OCCURS FOR A DISCRETE PERIOD OF TIME, episodic

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Lesion where causes bilateral coarse nystagmus worsening with visual fixation and present with horizontal and vertical gaze?

BRAINSTEM

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32 y/o pt 1-month hx of worsening headaches, episodic mood swings and occasional hallucinations with visual, tactile and auditory content. CT head reveals tumor where:

TEMPORAL LOBE

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Syndrome characterized by fluent speech, preserved comprehension, inability to repeat, w/o associated signs. Location of lesion in the brain?

SUPRAMARGINAL GYRUS OR INSULA

Wernicke’s?

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Acute onset of hemiballismus of LUE & LLE. MRI is most likely to show lesion located where?

SUBTHALAMIC NUCLEUS

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43 y/o newly AIDS pt has increasing social withdrawal and irritability over several weeks. Can’t remember phone number, unable to do chores, appears distracted. Mild right hemiparesis, left limb ataxia, and bilateral visual field defects. LP: normal cell counts, protein, and glucose. T2 Scan is shown. What is the diagnosis:

PROGRESSIVE MULTIFOCAL LEUKOENCEPHALITIS

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Unconsciousness can be induced by a small area of damage where?

RETICULAR FORMATION

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Pt who was admitted to the ER after a MVA receives IV dextrose 5% to provide access for administration of parenteral meds. Later, pt experiences confusion, oculomotor paralysis, and dysarthria. Symptoms were likely caused by:

WERNICKE’S ENCEPHALOPATHY

due to thiamine (B1) deficiency

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Pt reports headaches and peripheral visual loss. Visual field defects involving the temporal fields of both eyes are detected. An MRI scan is likely to reveal?

A MASS IN THE SELLA TURCICA

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A 35 yo F patient has discoid lupus which has long been controlled with a stable dose of oral prednisone. She abruptly develops increased fatigue, inflamed joints, and diffuse myalgias. Pt also exhibits depressed mood and cognitive impairment. She has no prior psychiatric history and no focal neurological signs. Which of the following is the most likely etiology?

DISEASE INDUCED CEREBRITIS

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25 y/o pt reports double vision and some difficulty with balance. On right lateral gaze, there is weakness of the left medial rectus, with nystagmus of the right eye. On left lateral gaze, there is weakness of the right medial rectus, with nystagmus of the left eye. There is also mild finger to nose ataxia on the right. Dx:

MULTIPLE SCLEROSIS

Intranuclear opthalmoplegia: inability to adduct ipsilateral eye (lesion in the left MLF, interrupts input to the left medial rectus, which would impair adduction of the left eye. For unclear reasons contralat eye develops nystagmus). So, A LEFT MLF LESION CAUSES LEFT INO.

Bilateral MLF lesions would cause bilateral INO, with the inability to adduct either eye on horizontal gaze.

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52 y/o M presents with a chief complaint of gait difficulties. On exam: mild dysarthria, very mild finger to nose ataxia and minimal heel to shin ataxia. Romberg test: negative, but very unsteady while walking and walks with a broad-based, lurching gait. The plantar reflexes are flexor. Imaging studies are most likely to demonstrate:

CEREBELLAR VERMIS ATROPHY

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The clinical syndrome associate with occlusion of the cortical branch of the posterior cerebral artery would result in which of the following?

HOMONYMOUS HEMIANOPIA WITH ALEXIA WITHOUT AGRAPHIA

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34 y/o M is referred for psychiatric evaluation 5 years after sustaining a head injury at work. Prior to the accident, he was a stable, happily married man. Since the accident, he has been described as overly talkative and restless. His wife divorced him because he was acting irresponsibly, which also resulted in termination from his job. Psychometric testing reveals that the man has average intelligence and no detectable memory deficits. Pt’s clinical presentation is most consistent with damage to which o the following brain areas?

FRONTAL LOBE

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Which hormone is secreted in functional pituitary adenoma:

PROLACTIN

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CT & MRI show ventriculomegaly are out of proportion to sulcal atrophy. This is suggestive of what diagnosis?

NORMAL PRESSURE HYDROCEPHALUS

20 y/o with 1-year h/o bitemporal headaches, polydipsia, polyuria, and bulimia plus 2-month h/o emotional outbursts, aggression, and transient confusion. Neuro exam normal. What will MRI of brain show?

HYPOTHALAMIC TUMOR

Unilateral hearing loss, vertigo, unsteadiness, falls, headaches, mild facial weakness and ipsilateral limb ataxia is most commonly associated with tumors in what locations?

CEREBELLOPONTINE ANGLE

38 y/o F with muscle spasm of the proximal limbs and trunk, lumbar lordosis while walking, w/o EMG abnormality and with serum antiglutamic acid antibodies is suffering from:

STIFF-PERSON SYNDROME

A pituitary tumor that protrudes through the diaphragmatic sella is most likely to cause?

BITEMPORAL HEMIANOPSIA

Conduction aphasia often occurs as a result of damage to which structure?

ARCUATE FASCICULUS

70 y/o develops flaccid paralysis following severe water intoxication. He develops dysphagia and dysarthria without other cranial nerve involvement. Sensory exam is limited but grossly normal, DTR’s are symmetric, and cognition is intact. Likely dx:

CENTRAL PONTINE MYELINOLYSIS

*62 y/o M w/ DM is not making sense, saying “thar szing is phrumper zu stalking”. Normal intonation but no one in the family can understand it. He verbally responds to Qs w similar utterances but fails to successfully execute any instruction. (8x)

WERNICKE’S APHASIA

*66 y/o with HTN develops vertigo, diplopia, nausea, vomiting, hiccups, L face numbness, nystagmus, hoarseness, ataxia of limbs, staggering gait, and tendency to fall to the left. Dx? (6x)

LATERAL MEDULLARY STROKE

*Chronic A-fib develops aphasia and R hemiparesis at noon. ER exam notes weakness of R extremities and severe dysfluent aphasia, but CT at 1:30 PM has no acute lesion. Most appropriate treatment: (4x)

TPA

*Rapid onset of right facial weakness, left limb weakness, diplopia:

BRAIN STEM INFARCTION

*A life threatening complication of cerebellar hemorrhage is:

ACUTE HYDROCEPHALUS

*A 72 yo patient had an embolic infarct in the middle cerebral artery territory. ECG shows no structural abnormalities. Doppler studies of the neck arteries reveal less than 50% occlusion on both carotid arteries. An EKG reveals AFib. Which of the following strategies has the best likelihood of reducing recurrent strokes in this patient?

ANTICOAGULATION WITH WARFARIN

*Young adult gained 70 lbs in last year c/o daily severe headaches sometimes assoc with graying out of vision. Papilledema present. CT and MRI brain no abnormalities but ventricles smaller than usual. Goal of treatment in this case:

PREVENT BLINDNESS

*68 y/o pt w/ hypertension develops rapidly progressing right arm and leg weakness, with deviation of the eyes to the left. Within 30 minutes of the onset of this deficit, pt became increasingly sleepy. Two hours after the onset, the patient became unresponsive. On exam: dense right hemiplegia, eyes deviated to the left, pupils: equal and reactive, a right facial weakness to grimace elicited by noxious stimuli. Cough and gag reflexes: present. Which CT finding is most likely?

LEFT PUTAMINAL HEMORRHAGE

*Superior homonymous quadrantic defects in the visual fields result from lesions to which of the following structures?

TEMPORAL OPTIC RADIATIONS

*78 y/o pt had an ischemic stroke that left him with a residual mild hemiplegia. Pt appeared to be unaware that there was a problem of weakness on tone side of this body. When asked to raise the weak arm, the patient raised his normal arm. When the failure to raise the paralyzed arm was pointed out to pt, he admitted that the arm was slightly weak. He also neglects the side of the body when dressing and grooming. Pt did not shave one side of his face, had difficulty putting a shirt on when it was turned inside out. Area of brain likely affected by stroke?

RIGHT PARIETAL LOBE

*A pt has multiple stoke like symptoms of short duration over several days. And has new onset symptoms for the last 90 minutes. CT scan shows no evidence of stroke or hemorrhage. What is the appropriate treatment?

INTRAVENOUS THROMBOLYTIC AGENTS

*MRI scan of head reveals an infarct in distribution of left anterior cerebral artery. Pt most likely exhibits:

WEAKNESS OF CONTRALATERAL FOOT AND LEG

50 y/o pt recently began having VH of children playing. VH are fully formed, colorful and vivid, but with no sound. Pt is not scared or disturbed, but rather amused. On exam, normal language, memory, cranial nerves, no weakness or involuntary movement, no sensory deficits. DTR: symmetric. CSF/UDS nml.

POSTERIOR CEREBRAL ARTERY ISCHEMIA

Right-side palsy with equal involvement of the face, arm and leg combined with third nerve palsy is most likely due to occlusion of a branch of which artery?

POSTERIOR CEREBRAL

Hemisensory loss followed by pain and hyperpathia involving all modalities and reaching the midline of trunk and head is most consistent with ischemia in the distribution of which of the following arteries?

POSTERIOR CEREBRAL

What is the most common manifestation of acute neurosyphillis?

STROKE

65 y/o pt wakes up with right-sided hemiparesis and motor aphasia. Pt is immediately brought to the emergency department and an evaluation is completed within 1 hour. Neurological exam: no additional abnormalities. Head CT w/o contrast: no additional abnormalities. Which is the appropriate next step in management?

ASPIRIN

65 y/o pt has a stroke which causes him to fall. On exam, weakness of the right leg, with only minor weakness of the right hand, no weakness of the face, no sensory deficit. Speech is not affected, but pt seems unusually quiet and passive. The stroke most likely involves the:

LEFT ANTERIOR CEREBRAL ARTERY

58 y/o M h/o HTN, cig smoking and sudden inability to speak. Face drooping on R and dragging R leg. In ER examined within 40 mins of onset: Aphasic, unable to understand or repeat verbal commands. Unintelligible sounds for speech. Alert but appears frustrated. R hemiplegia with arm and face weaker than leg. CT head: no hemorrhage. Pathology type and area:

THROMBOEMBOLIC STROKE OF LEFT MCA

Abulia refers to impairment in ability to:

SPONTANEOUSLY MOVE AND SPEAK

Sudden onset vertigo/nausea, hoarseness/dysphagia, right sided face numbness, diminished gag reflex on right, decreased pinprick and temperature sensation on left:

RIGHT MEDULLARY INFARCTION

65 y/o diabetic pt presents to ED c/o acute L sided weakness, deviation of gaze to R, L hemiplegia and hemisensory deficit, and L homonymous hemianopsia. 12 hrs later, pt is unconscious, L pupil enlarged and unreactive. CT will show what?

R MCA infarct w/ edema and UNCAL HERNIATION

Pt with acute onset vertigo, what will suggest R lateral medullary infarct?

RIGHT FACIAL LOSS OF TOUCH AND TEMPERATURE SENSATION

46 y/o M w/ double vision + pain R eye. Exam: ptosis R eyelid, inability to elevate or adduct R eye + R pupillary dilation. This is caused by:

POST. COMMUNICATING ARTERY ANEURYSM

Aphasia w/ effortful fragmented, non-fluent, telegraphic speech, is seen in a lesion where?

POSTERIOR FRONTAL LOBE

39 y/o pt with hx of multiple miscarriages develops an acute left sided hemiparesis. Work up reveals elevated anticardiolipin titers and no other risk factors for stroke. Appropriate intervention at this point is?

PLASMAPHERESIS

Abnormal elevated metabolic findings associated with increased risk of stroke in patients under 50

PLASMA HOMOCYSTEINE

70 y/o pt was hospitalized because of a middle cerebral artery stroke. The psychiatrist was asked to evaluate the pt. The pt has non-fluent aphasia. Which most likely characterized the pt’s interaction with the psychiatrist?

THE PT WAS ABLE TO FOLLOW THE VERBAL REQUEST, “CLOSE YOUR EYES.”

Acute onset of dense sensorimotor deficit in the contralateral face and arm, with milder involvement of the lower extremity, associated with gaze deviation toward the opposite side of the deficit, likely indicates occlusion of:

SUPERIOR DIVISION OF THE MCA

Weakness of extension at knee involves a lesion in which nerve?

FEMORAL

CT scan with occipital and intraventricular hyper-intensities:

PARENCHYMAL HEMORRHAGE

Which med has secondary prevention against embolic stroke in pts with A-fib?

ORAL WARFARIN

As opposed to strokes caused by arterial embolism or thrombosis, those caused by cerebral vein or venous sinus thrombosis are:

ASSOCIATED WITH SEIZURES AT ONSET

Atrophy of right temporal lobe on cross section associated with occlusion of:

MIDDLE CEREBRAL ARTERY

Loss of ability to execute previously learned motor activities (which is not the result of demonstrable weakness, ataxia or sensory loss) is associated with lesions of?

LEFT PARIETAL CORTEX

58 y/o s/p CABG – anomia for fingers and body parts, errors involving right and left, inability to write thoughts/take notes/make calculations. Fluent speech and excellent comprehension

LEFT MEDIAL TEMPORAL STROKE

Visual disturbances associated with occlusion of the right posterior cerebral artery?

LEFT HOMONYMOUS HEMIANOPSIA

65 y/o w/ HTN collapsed. In ED is stuporous, R hemiparesis + hemisensory deficit, eyes deviate to L. CT would show intraparenchymal hemorrhage in:

LEFT BASAL GANGLIA

Lower facial weakness w/ relative sparing of forehead, stroke in?

INTERNAL CAPSULE

Higher frequency & greater severity of depression associated w/ cortical & subcortical strokes:

LEFT ANTERIOR FRONTAL

68 y/o pt is depressed following a hip surgery. Pt is withdrawn, looks blank, shows dysarthria, weakness, PMR, hyperreflexia, and has trouble swallowing. MRI of the head will show:

PERIVENTRICULAR WHITE MATTER DEMYELINATION

Prognosis of acute inflammatory demyelinating polyneuropathy is poorest if the disease process involves which of the following?

PROXIMAL AXON

Pt with HTN develops painless vision loss in the left eye. Exam: blindness in L eye and afferent pupillary defect on the left. MRI: several T2 hyperintensities in the white matter periventricularly. No corpus callosum lesions. No enhancement with gadolinium. Dx?

ISCHEMIC OPTIC NEUROPATHY

63 y/o with new onset aphasia and R hemiparesis, 2 days ago had milder/similar symptoms that resolved in 30 minutes, yesterday had similar episode x 45 minutes. Current Sx started 1.5 hrs ago. CT shows no stroke or hemorrhage. Tx?

INTRAVENOUS THROMBOLYTIC AGENTS

57 y/o diabetic pt =w/ HTN c/o several episodes of visual loss, “curtain falling” over his L eye, transient speech and language disturbance, and mild R hemiparesis that lasted 2 hrs. Suggests presence of what?

EXTRACRANIAL LEFT INTERNAL CAROTID STENOSIS

Head injury, LOC -> lucid interval x hours -> rapid progressing coma. Hemorrhage?

EPIDURAL

5 days after CABG a 47 y/o M is disoriented to time and place. He identifies his right and left but not that of the examiners. Can draw square and circle but not a clock. This is:

DYSPRAXIA

Pt in ED with sudden HA and collapsing, some lethargy. Exam shows rigid neck, no papilledema, no focal CN or motor signs. The initial test should be?

CT HEAD

Poststroke depression in 80 yo pt (R handed) is assoc w cognitive impairments that:

CORRELATE WITH LEFT HEMISPHERIC INVOLVEMENT

Fluent speech w preserved comprehension, inability to repeat statements is consistent with what type of aphasia?

CONDUCTION

Normal Romberg w/ eyes open but loses balance with eyes closed. Where is the abnormality?

CEREBELLAR VERMIS

65 y/o w/ hx of HTN, Meniere’s with sudden vertigo, N/V, worse with head movement, R beating nystagmus on lateral gaze, finger to nose testing is ataxic, poor balance and dysarthria. Dx?

CEREBELLAR INFARCT

66 y/o M in ED w/ sudden occipital HA, dizziness, vertigo, N/V, unable to stand, mild lethargy, slurred speech. Exam: small reactive pupils, gaze deviated to the R, nystagmus, w/ occasional ocular bobbing, R facial weakness, decreased R corneal reflex, truncal ataxia, b/l hyperreflexia, b/l Babinski. Dx?

CEREBELLAR HEMORRHAGE

Motor speech paradigm activation task on fMRI – hyperactivity in right temporal lobe. Damage is where?

CALCARINE FISSURE

Inability to recognize objects by touch:

ASTEREOGNOSIS

In managing acute ischemic stroke, administer this within 48 hrs of onset of stroke for beneficial effect in reducing risk of recurrent stroke, disability and death:

ASPIRIN

70 y/o pt w/ attacks of “whirling sensations” w/n/v, diplopia, dysarthria, tingling of lips. Occurs several times daily for 1 minute, severe that pt collapses and is immobilized when symptoms start. No residual s/s, no tinnitus, hearing impairment, ALOC or association with any particular activity. Dx?

VERTEBROBASILAR INSUFFICIENCY

Component of type A behavior most reliable risk factor for CAD

HOSTILITY

Vascular lesion most characteristic of sudden severe headache, vomiting, collapse, relative preservation of consciousness, few or no lateralizing neurological signs, and neck stiffness:

SUBARACHNOID HEMORRHAGE

Head CT demonstrates which dx (grainy picture with diffuse speckling in posterior region, unilateral)

SUBARACHNOID HEMORRHAGE

Pt w/ sudden onset of L hemiparesis, L homonymous hemianopsia, tendency to gaze to right, and neglect left sided stimuli are deficits most likely result of occlusion of:

RIGHT MIDDLE CEREBRAL ARTERY

70 y/o F sudden onset paralysis R foot and leg. R arm and hand slightly affected. No aphasia or visual field deficit. Over weeks found with loss of bladder control, abulia and lack of spontaneity. Which vascular area:

ANTERIOR CEREBRAL ARTERY (LEFT)

*72 w/ recent behavior/memory problems. Disrobing, not sleeping, irritable. Waxing and waning consciousness. Dx? (8x)

DELIRIUM

*79 y/o pt w/ decreasing mental state over 3 weeks has an exaggerated startle response with violent myoclonus that is elicited by turning on the room lights, speaking loudly, or touching the patient. Myoclonic jerks occur spontaneously, ataxia, EEG: sharp waves. Dx: (5x)

SUBACUTE SPONGIFORM ENCEPHALOPATHY

*52 y/o pt w/ hx of depression & HTN hospitalized, being evaluated by psych resident. His family reports he had severe HA & “has not been himself” for 10 days. On exam, pt has poor eye contact and is inattentive, muttering, picking at his clothes, occasionally dozing off although it is midday. Dx: (4x)

DELIRIUM

*Mild confusion, lethargy, thirst, polydipsia:

HYPONATREMIA

Subacute spongiform encephalopathy