Neurology

Question 1

Non-dominant parietal lesion - clinical signs

Answer 1

Inattention
Neglect
Impaired constructional ability

Question 2

Dominant parietal lobe lesion - clinical signs

Answer 2

Gerstmann's syndrome:
Finger agnosia
Agraphia
Acalculia
Right-left disorientation

Question 3

Gerstmann’s syndrome

Answer 3

Finger agnosia
Agraphia
Acalculia
Right-left disorientation

• Due to dominant parietal lobe lesion (eg. left PCA stroke)

Question 4

Common peroneal neuropathy

Answer 4

Inability to heel walk
Foot drop
Weakness - foot eversion (not inversion, due to intact posterior tibial), dorsiflexion
Sensory - lateral aspect dorsum foot
Reflex - intact

Question 5

L5 radiculopathy

Answer 5

Inability to heel walk
Foot drop (foot dorsiflexion)
Weakness - foot inversion and eversion, knee flexion
Sensory - dorsum foot
Reflex - hamstring loss, ankle intact

Question 6

S1 radiculopathy

Answer 6

Inability to toe walk
Weakness - plantar foot extension, hip extension, knee flexion, toe flexion
Sensory - plantar/lateral foot
Reflex - ankle jerk loss

Question 7

Internuclear opthalmoplegia (INO)

Answer 7

Injury to medial longitudinal fasciculus (MLF) within the dorsomedial pontine or midbrain tegmentum.

Symptoms:
Ipsilateral adduction weakness
Contralateral nystagmus
Normal convergence

Question 8

Anton’s syndrome

Answer 8

Denial of blindness

• Due to bilateral posterior cerebral artery infarction

Question 9

Causes of deep intracerebral haemorrhage (eg. putamen, thalamus, brainstem, cerebellum)

Answer 9

Hypertension

Rupture of deep penetrating arteries

Question 10

Causes of lobar intracerebral haemorrhage (eg. cortex, subcortical white matter)

Answer 10

Amyloid angiopathy
Tumour
Arteriovenous malformation
Aneurysm

Question 11

Most common Guillain-Barre syndrome (GBS) precipitating infections

Answer 11

Campylobacter jejuni gastroenteritis
HIV
Influenza-like illness
CMV
EBV
Mycoplasma pneumoniae

Question 12

Guillain-Barre syndrome - diagnosis

Answer 12

CSF - albumino-cytologic dissociation (high protein, normal white cell count)
NCS - prolonged/absent F-waves, proximal block (distal conduction velocities normal)
GM-1 - 40-50% GBS
GQ1b - in Miller Fisher variant

Question 13

Progressive supranuclear palsy (PSP) - presentation

Answer 13

Parkinson’s plus syndrome
Gait disturbance
Falls
Opthalmoplegia - occurs late (3-5 years)

Question 14

Lewy Body dementia (LBD) - presentation

Answer 14

Parkinson’s plus syndrome
Visual hallucinations
Fluctuating cognition
Parkinsonism

Question 15

Corticospinal degeneration (CSD) - presentation

Answer 15

Parkinson's plus syndrome
Progressive asymmetric movement disorder (affects 1 limb initially)
Akinesia
Rigidity
Focal myoclonus
Alien limb phenomena

Question 16

Multiple systems atrophy (MSA) - presentation

Answer 16

Parkinson's plus syndrome
Dysautonomia
Orthostatic hypotension
Urinary dysfunction
Cerebellar involvement
Pyramidal signs
Cognitive function preservation

Question 17

Hemiballismus

Answer 17

Flailing undesired movements of limb

• Due to damage to basal ganglia (particularly subthalamic nucleus)

Question 18

Normal pressure hydrocephalus (NPH) - presentation

Answer 18

Gait instability
Urinary incontinence
Dementia

Question 19

Internal carotid artery dissection (ICAD) - presentation

Answer 19

Headache
Posterior circulation stroke
Horner syndrome
Amaurosis fugax

Question 20

Vertebral artery dissection (VAD) - presentation

Answer 20

Headache
Posterior circulation stroke
Neck pain
Subarachnoid haemorrhage
(no Horner's or blindness)

Question 21

Vertigo - peripheral signs

Answer 21

Head impulse test positive
No brainstem symptoms
Horizontal nystagmus
- suppresses with fixation
- doesn't change direction with gaze

Question 22

Vertigo - central signs

Answer 22

Head impulse test negative
Brainstem signs
Head tilt/skew deviation
Nystagmus
- may be horizontal, vertical, torsional
- doesn't suppress with fixation
- may change direction with gaze

Question 23

Vertigo - benign paroxysmal positional vertigo (BPPV)

Answer 23

Peripheral signs
Head movement/position precipitates symptoms
Dix-Hallpike positive

Question 24

Vertigo - Meniere disease

Answer 24

Peripheral signs
Tinnitus, aural fullness
Sensorineural hearing loss

Question 25

Vertigo - gentamicin toxicity

Answer 25

Peripheral signs
Bilateral vestibulopathy (most common cause)
- eg. bilateral head impulse positive

Question 26

Traumatic brain injury - epidural haematoma

Answer 26

Biconvex (lentiform) on CT
Skull fracture related
Due to arterial rupture

Question 27

Traumatic brain injury - subdural haematoma

Answer 27

Crescentic on CT
Falls related
Due to venous tearing