Neurology: Brain Lesions Flashcards
Visual problem in pituitary tumor compressing optic chiasm: (10x)
BITEMPORAL HEMIANOPSIA
Unsteady gait, appendicular ataxia in LE only and normal eye
movement. Walks with lurching broad-based gait. Dx? (8x)
CEREBELLAR DEGENERATION (ALCOHOLIC)
66 yo 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: (8x)
PROGRESSIVE SUPRANUCLEAR PALSY
Severe occipital HA, BL papilledema and no other abnormalities.
Chronic acne treated with isotretinoin. Lumbar puncture elevated
opening pressure with no cells, 62 mg/dl glucose, and 22mg/dl
protein. CT is normal. Dx? (7x)
PSEUDOTUMOR CEREBRI
79 yo pt with a deteriorating mental state over a 3-week period has
an exaggerated startle response with violent myoclonus that is
elicited by turning on the room lights, speaking loudly, or touching
the pt. Myoclonic jerks are also seen. Diagnosis: (5x)
SPONGIFORM ENCEPHALOPATHY
Pt presents with a slowly progressive gait disorder, followed by
impairment of mental function, and sphincteric incontinence. No
papilledema or headaches are reported. Likely diagnosis? (4x)
NORMAL PRESSURE HYDROCEPHALUS
65 yo 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
Pt w/ acute onset of pain and decreased vision in the R eye. Colors
look faded when viewed through the R eye. On exam, has a R
afferent pupillary defect and a swollen right optic disc. Pt
spontaneously recovers over the next 6 wks. Likely to develop later:
(4x)
MULTIPLE SCLEROSIS
28yo with emotional lability and impulsivity. LFT’s elevated. Close
relative had similar sx and died at 30 yo from hepatic failure. Which
blood level would be diagnostic? (3x)
CERULOPLASMIN
Pt with several days of fever and severe headaches presents to ED
b/o generalized seizure. Pt is confused and somnolent. Also
reported to have been irritable and has c/o foul smells. T2 MRI
displayed (hyperintensity of left temporal). Dx? (3x)
HERPES ENCEPHALITIS
9YO YO 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?
HYPOTHALAMIC HAMARTOMA
5 yo with 4 month history of morning HA, vomiting, and recent
problems with gait, falls, and diplopia: (2x)
MEDULLABLASTOMA
70 yo 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: (2x)
CENTRAL PONTINE MYELINOLYSIS
Young adult gained 70 lbs in last year c/o daily severe headaches
sometimes associated with graying out of vision. Papilledema
present. CT and MRI brain no abnormalities but ventricles smaller
than usual. Goal of treatment in this case: (2x)
PREVENT BLINDNESS
Superior homonymous quadrantic defects in the visual fields result
from lesions to which of the following structures? (2x)
TEMPORAL OPTIC RADIATIONS
TREMOR WITH A FREQUENCY OF AROUND 3 HZ, IRREGULAR AMPLITUDE, MOST EVIDENT TOWARD THE END OF REACHING MOVEMENTS. DX?
CEREBELLAR TUMOR
Acute onset of fever, sore throat, diplopia, & dysarthria. Exam
reveals an inflamed throat, left adductor nerve palsy w/ impairment
of vertical pursuit, diffuse hyperreflexia w/ bilateral clonus, lower
ext spasticity, & mild right hemiparesis. CT is uninformative. Spinal
fluid has protein of 24, 10 mononuclear cells, and glucose of 70. Dx?
(2x)
MULTIPLE SCLEROSIS
Which is the most reliable finding from CSF analysis for a pt with
multiple sclerosis in the chronic progressive phase of the dz? (2x)
PRESENCE OF OLIGOCLONAL BANDS
Benign intracranial HTN etiology: (2x)
HYPERVITAMINOSIS A
Gait abnormality, slow movement, asymmetric UE rigidity. Difficulty
in voluntary vertical upward/downward gaze. Slowness/rigidity
improved slightly with levodopa. Later has problems with horizontal
& vertical gaze. Oculocephalic reflexes normal. Involuntary saccades.
Dx? (2x)
PROGRESSIVE SUPRANUCLEAR PALSY
Pt presents with personality changes, cognitive difficulties, affective
lability, and olfactory and gustatory hallucinations. The most likely
medical cause of this presentation is: (2x)
HERPES SIMPLEX VIRUS INFECTION
WHAT CONDITION IS A FORERUNNER OF MS? (2X)
TRANSVERSE MYELITIS
Location of characteristic lesions seen in CT scans of pt with carbon
monoxide poisoning associated comas: (2x)
GLOBUS PALLIDUS
43 yo newly w/ 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? (2x)
PROGRESSIVE MULTIFOCAL LEUKOENCEPHALITIS
