Stephens Review

Question 1

PPRF (Pyramidal Pontine Reticular Formation?) lesion is usually associated with what other lesion?

Answer 1

Lesion to abducens nucleus because the PPRF is surrounding the abducens nucleus

(Motor disorder)

Question 2

Parkinson’s disease associated with which part of brain

Answer 2

Substantia nigra pars compacta (dopaminergic neurons)

Motor disorder

Question 3

Degeneration of the corpus stratium (caudate, putamen, globus pallidus)

Answer 3

Huntington’s chorea

Motor Disorder

Question 4

Neuro anatomical structure associated with hemiballism

Answer 4

SUBTHALAMUS (very small lesion can cause substantial change)

• -unilateral flailing arm
• -can’t sleep

Question 5

Is internuclear opthalmoplegia unilateral or bilateral?

Answer 5

Can be either unilateral or bilateral

Question 6

Cerebellar medulloblastoma affects what age group

Answer 6

Usually young, but can also affect older patients!

Question 7

Cerebellar medulloblastomas if unilateral or any cerebellar lesion leads to what kind of deficits? What about vestibular lesions? Ipsilateral or contralateral? What if the lesion is in the midline?

Answer 7

Ipsilateral deficits

If lesion is in midline, the deficit will result in truncal abnormalities (postural impairment, Romberg sign, etc)

Question 8

55 year old male oil rig worker was referred to the Neuro Dpt for consultation from the chemical dependency unit. Mr. Elkins had complained about CLUMSINESS and DIFFICULTY WALKING which had progressively worsened over the last few years. Neurological exam revealed a poorly nourished individual who appeared CONFUSED, SLIGHTLY DISORIENTED with respect to TIME. Other signs and symptoms included a BROAD, ATAXIC GAIT; DYSMETRIA ON FINGER TO NOSE TEST; DYSDIADOCHOKINESIA; UNCOORDINATED MOVEMENTES on heel to shin test; and no muscle weakness.

Answer 8

-Alcoholic Cerebellar Degeneration

• long term history associated with it
• cerebellar symptoms
• also associated with Korsakoff’s syndrome

Question 9

Apathy, change in personality, habit; hard to test for memory and recall because they don’t care (apathetic)

Answer 9

Frontal Lobe Syndrome

Question 10

Bilateral spastic paralysis
Dysesthesias of the legs and feet
Can also cause frontal lobe syndrome?

Answer 10

Parasagittal Meningioma

Question 11

58 year old advertising executive with a history of hypertension collapsed up the parking lot of his building and was brought to the hospital by ambulance. Neuro exam after consciousness revealed:
-Hemianalgesia and thermal hemianesthesia on left side of body and face
-Proprioception 2 pt tactile sensations were absent from the left side of body and slightly diminished on left side of the face
Slow pain sensations were vaguely perceived on the left side of body and face
-Left spastic hemiplegia with hyperreflexia and BABINSKI
-Inability to smile on the left side
-Left homonymous hemianopsia

Answer 11

Infarct of the RIGHT internal capsule

Lesion in the Genu and the posterior limb of the internal capsule
-80% of infarcts in the cerebral hemispheres are in the internal capsule and basal ganglia

Question 12

Know definitions of anosmia, alexia, agraphia

Answer 12

Look up!

Question 13

33 year old railroad worker, was brought to the company physician by a coworker who found him wandering aimlessly around the tracks picking his nose. The brakeman had no recollection of the incident. The last thing he remembered was that he was walking to work when he smelled something burning, then he remembered seeing gigantic trains running up and down the highway. He was admitted to a psychiatric hospital for evaluation. There he began hallucinating and suffered amnesia and nightmares more frequently. Neurological exam revealed a LEFT SUPERIOR HOMONYMOUS QUADRANTOPIA. Where is the lesion? Diagnosis?

Answer 13

Posterior portion of the right temporal lobe (a little bit of parietal lobe)

• Lesion of the RIGHT loop of Meyer
• Dx: Anterior Temporal Lobe tumor with Left Superior QUADRANTOPIA

Question 14

73 year old woman was referred to a neurologist with a chief complaint of HEARING DIFFICULTIES. She also had some difficulty UNDERSTANDING WHAT PEOPLE SAID TO HER even when they talked loud enough for her to hear. She did not think she was becoming senile because she UNDERSTOOD PERFECTLY EVERYTHING SHE READ.

Answer 14

-Auditory Aphasia (AGNOSIA)

Question 15

What kind of disorders can involve the Paracentral lobule

Answer 15

Meningioma of the superior sagittal sinus or the Falx cerebri (superior sagittal thrombosis)
ACA Thrombosis
Also an ACA aneurysm can cause frontal lobe syndrome

Question 16

Frontal Lobe syndrome secondary to vascular cause ACA aneurysm buzz words

Answer 16

“Angiography confirmed diagnosis” for vascular cause

“CT or MRI confirmed diagnosis” if caused by tumor

Question 17

20 year old track athlete, went to his team doctor complaining of some weakness in his legs. He said his legs felt tired when he stood up too long. Exam revealed increased patellar reflexes but normal Achilles reflexes in both lower limbs. Two months later, Mr. Garcia’s limbs had continued to weaken until he was unable to walk. Exam at this time revealed SPASTIC PARALYSIS AND INCREASED PATELLAR AND ACHILLES REFLEXES IN BOTH LOWER LIMBS. BABINSKI SIGNS WERE ELICITED BILATERALLY. Diagnosis?

Answer 17

Parasagittal Meningioma–Anterior Paracetral lobule and Frontal Lobe syndrome

Question 18

66 year old retired graphic artist was brought with reluctance by his wife who was concerned about his recent behavior. He didn’t know what to do with himself anymore. He would wander around the house and had difficulty finding the front door although he seemed to be able to see all right. Wife was frightened when he started to go on to bed with his left shoe and sock on. He also left the left half of his shirt and trousers on. His left arm and leg were always seen to be hanging off the side of the bed. One night he undressed his left side after he went to sleep only to find that he neglected to dress his left side when he got up the next morning. The man’s only complaint was that, although he was an artist, he no longer seemed able to draw anything properly.

Answer 18

• Neglect of Body scheme
• Not necessarily parietal lobe–can be localized in other areas
• Also called hemineglect
• Contralateral deficit

Question 19

63 year old retired acountant came to his doctor complaining that he was no longer able to read or write. Exam revealed no defect in the visual fields or eye movements. He could recognize and identify objects in both visual fields but he could not read. He understood everything that he was told and responded to questions well but occasionally seemed to miscue a word or two. When given a pencil, paper and drawing of a sail boat, he became confused and could not determine WHICH FINGERS TO USE or decide WHICH HAND WAS RIGHT OR LEFT. The doctor told him not to worry and he picked up the pencil and drew an accurate copy of the boat. Later tests determined that he had considerable DIFFICULTY WORKING ARITHMETIC PROBLEMS despite his determination and prior ability to solve them

Answer 19

Gertsman’s Syndrome

• Right hand left hand disorientation
• Finger AGNOSIA–can’t tell them apart
• when given pencil they will take with dominant hand
• math–dyscalculia

Question 20

65 year old admitted to hospital after 3 year history of an insidious onset of FORGETFULNESS and IMPAIRED JUDGEMENT with occasional ACUTE EPISODES OF DISORIENTATION in time and place. 3 months prior to admission she required frequent ASSISTANCE WITH THE BASIC ACTIVITIES OF DAILY LIVING and urinary incontinence. She could not bathe or groom herself because she could not remember how to do these simple tasks. If she left the house she would immediately forget where she lived or where she had been. Neuro exam revealed marked DISORIENTATION IN TIME AND SPACE, MIXED APHASIA, APRAXIA, PATHOLOGIC MOUTH OPENING RESPONSES, A GRASP REFLEX ON THE RIGHT AND HYPERREFLEXIA OF ALL EXTREMITIES. CT scan showed marked DILATION OF THE VENTRICLES and SUBARACHNOID space and indicated the final diagnosis

Answer 20

Alzheimer’s Disease (cortical dementia?)

Question 21

87 year old woman has a significant history of multiple strokes including some in the parietal-temporal cortex of the dominant hemisphere. Mrs. Conrad was received a language by a speech pathologist. She has difficulty in understanding speech or pictures. Words are used in wrong order or are omitted. Word finding difficulties. Neologisms or new word creations. Some preservation

Answer 21

Wernicke’s aphasia

• circumlocution of language, new word creations, word substitutions, multiple strokes?
• what is said is inner voice and are usually not upset; in contrast people with Broca’s aphasia patients are more upset/agitated

Question 22

Episodic vs Progressive Disorders

Answer 22

Episodic: Bilateral Internuclear Opthalmoplegia
Progressive: Tumors and Degenerative Diseases

Question 23

Tumors

Answer 23

Cerebellar Medulloblastoma
Temporal Lobe tumor

(Progressive)

Question 24

Degenerative disorders

Answer 24

(Progressive)

• AD
• Friedrich’s Ataxia
• Huntington’s Chorea
• Fontal Lobe syndrome
• Parkinson’s Disease
• Alcoholic Cerebellar Degeneration

Question 25

THings to know

Answer 25

• INO
• Korsakoff’s syndrome
• Alcoholic degeneration
• Frontal Lobe syndrome
• Paracentral lobule

Question 26

63 year old, right handed commercial real estate broker experienced sudden onset of DYSESTHESIA OVER THE ENTIRE LEFT SIDE of the body associated with dizziness. There was a previous history of mild diabetes mellitus and moderate hypertension which was controlled by medication. The dizziness disappeared rapidly but within one week Mr. Hubbard was completely DISTRAUGHT. He became RESTLESS AND AGITATED and COULD NOT SIT due to DISCOMFORT IN HIS LEFT LEG which was kept constantly in motion

Answer 26

Thalamic Syndrome (Dejerine Roussey Syndrome)–Brainstem Lesion

• Tingling sensation in one half of body, numbness
• feels like crawling ants
• Suicidal