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Neurology > Neurosurgery formative > Flashcards

Neurosurgery formative Flashcards

1
Q

Where does the corticospinal tract originate?

A

Primary motor cortex in the precentral gyrus

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2
Q

What are the 2 parts of the corticospinal tract and what are their functions?

A
  • Lateral corticospinal tract (pyramidal decussation) - voluntary motor control of limbs and digits
  • Anterior corticospinal tract (segmental decussation) - voluntary motor control of the trunk and maintains posture
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3
Q

Where does the corticobulbar tract originate from?

A

Primary motor cortex in the precentral gyrus

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4
Q

What is the function of the corticobulbar tract?

A
  • Controls the muscles of face, head and neck (contains UMNs of cranial nerves)
  • Bilateral innervation to cranial nerve nuclei except CN XII and lower part of CN VII
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5
Q

Where is the lesion in Bells palsy?

A

Lower motor neuron of CN VII causing forehead and lip droop

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6
Q

If there was an UMN lesion to CN VII e.g. stroke, how would that manifest itself in a patient?

A

Lip droop with forehead SPARING due to bilateral innervation

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7
Q

What is the origin and function of the rubrospinal tract?

A
  • Origin - red nucleus in the midbrain
  • Function - excites flexor muscles and inhibits extensor muscles of the upper body
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8
Q

What is the origin and function of the reticulospinal tract?

A
  • Originates in the pons/medulla
  • Function - excites extensors
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9
Q

What are the features of decerebrate rigidity?

A

Plantar flexed, wrists and fingers flexed, forearms pronated, elbows extended and shoulders adducted

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10
Q

What are the features of decorticate rigidity?

A

Plantar flexed, legs internally rotated, wrists and elbows flexed, arms adducted

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11
Q

What is the function of the DCML pathway and where does it decussate?

A
  • Function - responsible for fine touch, pressure and vibration
  • Decussate in medulla to contralateral medial lemniscus to reach the primary somatosensory area in the postcentral gyrus
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12
Q

What is the function of the spinothalamic tract and where does it decussate?

A
  • Function - conveying pain and temperature
  • Decussate segmentally in the spinal cord to reach the opposite primary somatosensory cortex
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13
Q

A 30 year old man presented with a stab wound in his back. He has right sided weakness starting at T5 and left sided loss of pinprick sensation and temperature starting at T7. What spinal cord compression syndrome did this man develop?

A

Brown-Sequard syndrome

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14
Q

A 39-year-old woman presented with severe headaches whenever she sneezed. She also had decreased sensation to pinprick over her upper back, shoulders, and upper arms. Her power in her arms was 2/5 but her lower body power was 5/5. What is the cause for patient’s sensation and motor weakness?

A

Syringomyelia

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15
Q

Where do extradural haemorrhages originate and how do they present?

A
  • Located between skull and dura
  • Origin - arterial (middle meningeal artery)
  • Presentation - mainly in young patients due to head trauma, lucid interval followed by unconsciousness
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16
Q

How are extradural haemorrhages investigated and what would be the findings?

A
  • CT scan
  • Hyperdense BICONVEX lens appearance
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17
Q

Where do chronic subdural haemorrhages originate and how do they present?

A
  • Located between dura and arachnoid
  • Venous origin (cerebral bridging veins)
  • Presentation - older patients due to low impact trauma, progressive headache and confusion
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18
Q

How are subdural haemorrhages investigated and what would be the findings?

A
  • CT scan
  • Hypodense CRESCENT shaped appearance
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19
Q

Where do subarachnoid haemorrhages originate and how do they present?

A
  • Located between arachnoid and pia
  • Origin - arterial
  • Presentation - due to severe head injuries or ruptured berry aneurysm
  • Symptoms - severe thunderclap headache, meningeal irritation and loss of consciousness
20
Q

How are subarachnoid haemorrhages investigated and what would be the findings?

A
  • CT scan initially, CT angiogram gives definitive diagnosis
  • Hyperdense signal in the subarachnoid space
21
Q

What does cerebral herniation cause?

A
  • Increased ICP due to any space occupying lesions
  • Symptoms - extensor response, Cushing’s triad (hypertension, bradycardia and irregular breathing), unreactive pupil (uncal herniation)
22
Q

A patient presents unconscious with unilateral pupil mydriasis that does not constrict to light following a car accident. On CT, an intracranial hemorrhage with cerebral herniation. What is the most likely cause?

A

Uncal herniation

23
Q

A 66-year-old man presented with several falls over the course of the past few months. On examination, he had symmetrical weakness of his legs and mild weakness of his hand. He had an abnormal gait. His reflexes were extremely brisk in his legs with upgoing planters bilaterally. He has positive Hoffman’s sign. What is the most likely diagnosis?

A

Degenerative cervical myelopathy due to cervical spondylosis

24
Q

Label each of the arteries 1-9 (starting from top right and working anti-clockwise)

A

1 - middle cerebral 2 - ophthalmic 3 - internal carotid 4 - basilar 5 - vertebral 6 - posterior cerebral 7 - posterior communicating 8 - anterior cerebral 9 - anterior communicating

25
Q

What are the features of an anterior circulation stroke?

A
  1. higher cerebral dysfunction e.g. dysphasia
  2. homonymous visual field defect
  3. contralateral motor and/or sensory deficit of at least 2 areas (out of face, arm and leg)
26
Q

What are the features of a posterior circulation stroke?

A
  • Cerebellar dysfunction
  • Isolated homonymous visual field defect
  • Cranial nerve dysfunction
27
Q

What are the features of lacunar stroke?

A

A pure motor or sensory stroke

28
Q

What kind of stroke does this patient have?

An 80-year-old ex-smoker with uncontrolled hypertension presented with the acute onset of numbness of his left arm and leg. On examination, there was decreased sensation to all his left side of the body and face.

A

Lacunar stroke

29
Q

What kind of stroke does this patient have?

A 66-year-old female with atrial fibrillation presents with dysphasia and left hemiparesis

A

Partial anterior stroke

30
Q

What kind of stroke does this patient have?

A 70-year-old male with left homonymous hemianopia. He has no other symptoms

A

Posterior circulation stroke

31
Q

Match the area of the brain corresponding with a lesion that would cause expressive dysphasia, receptive dysphasia and a lesion that would cause nystagmus, intention tremor and dysarthria respectively

A
  • Expressive dysphasia - 2 (Broca’s area)
  • Receptive dysphasia - 4 (Wernicke’s area)
  • Nystagmus, intention tremor and dysarthria - 6 (cerebellum)
32
Q

Where is the primary auditory cortex found?

A

Superior temporal gyrus

33
Q

What controls the temperature of the body?

A

Hypothalamus

34
Q

What contains the oculomotor nucleus?

A

Midbrain

35
Q

Where would the tumour be found in this patient?

A 7 year old boy presents with progressive headache, wide based ataxia and difficulty speaking. Imaging and biopsy confirms the presence of a pilocytic astrocytoma.

A

Cerebellum

36
Q

Where would the tumour be found in this patient?

A 56-year-old man presented to the hospital with a seizure. He had been complaining of headaches for the past several months and has been “bumping into things”. On examination, it was revealed that he has a left superior quadrantopia. Imaging and biopsy confirmed a Glioblastoma multiforme

A

Right temporal lobe

37
Q

Where would the tumour be found in this patient?

A 40 year old right-handed accountant presents with difficulty in writing and that he ”wasn’t as good with numbers as before”. On examination, he had a left-right disorientation. Imaging and biopsy confirmed the presence of a meningioma

A

Left parietal lobe

38
Q

What is the most likely cause of this patient’s symptoms? A 6-month-old girl presented with a head circumference rising from the 66th to the 99th percentile and failure to thrive. On examination, when the lids are retracted, the eyes look like they are sunsetting, and upward gaze is impaired.

A

Non-communicating hydrocephalus due to aqueduct stenosis

39
Q

What is the most likely cause of this patient’s symptoms? A 75 year old patient presents with a progressive shuffling gait and urinary incontinence. He denies any back pain. His wife is claiming that he has been forgetting his keys and taking his medication.

A

Normal pressure hydrocephalus

40
Q

What is the most likely cause of this patient’s symptoms? A 56-year-old man presents with a headache, severity 8/10 with associated nausea. On examination he has ptosis, and miosis.

A

Internal carotid dissection

41
Q

What is the most likely cause of this patient’s symptoms? A 56-year-old man presents with a progressive headache, severity 6/10 with associated nausea. On examination he has ptosis, and a right dilated unreactive eye.

A

Posterior communicating artery aneurysm

42
Q

What is the most likely cause of this patient’s symptoms? A 56-year-old man presents with a headache, severity 10/10 with associated vomiting. On examination he has neck stiffness and photophobia.

A

Subarachnoid haemorrhage

43
Q

What is the most likely cause of this patient’s symptoms? A 40-year-old obese lady on the contraceptive pill develops headaches first thing in the morning which are worse on coughing. She is complaining of double vision.

A

Sixth nerve palsy

44
Q

What is the most likely cause of this patient’s symptoms? A 55 year old man develops diplopia after a closed head injury accident. He says the diplopia is worse when he is going down the stairs. On examination, you see he has a head tilt to the right.

A

Fourth nerve palsy

45
Q

What is the most likely cause of this patient’s symptoms? A patient develops retro-orbital pain in his right eye described as a boring, worst pain he has ever felt, lasting 20 minutes. Associated tearing of that eye and a stuffy nose. He has 10 episodes of this pain for the past week.

A

Cluster headache

46
Q

A 30-year-old female presented with double vision and ataxia. Three years earlier she had an episode where she lost vision in her left eye for two weeks. On exam, she was mildly ataxic, with brisk reflexes, and both horizontal and vertical nystagmus. What is the most likely diagnosis?

A

Multiple sclerosis

Neurology (18 decks)

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