Symptoms of Neuro conditions

Question 1

What are symptoms of a TIA where the anterior cerebral artery is blocked?

Answer 1

Weak and numb contralateral leg

Question 2

What are symptoms of a TIA where the middle cerebral artery is blocked?

Answer 2

Weak and numb contralateral side of body
Face drooping with forehead spared
Dysphasia

Question 3

What are symptoms of a TIA where the posterior cerebral artery is blocked?

Answer 3

Vision loss (contralateral homonymous hemianopia with macular sparing)

Question 4

What are symptoms of a TIA where the vertebral artery is blocked?

Answer 4

Cerebellar syndrome (think DANISH):
Dysdiadochokinesis
Ataxia
Nystagmus
Intention tremor
Scanning dysarthria
Heel-shin positive

Question 5

Speech and visual disturbance with numbness or weakness in face, arms and legs for 15 minutes

Answer 5

TIA

Question 6

Limb and facial weakness down one side, dysphasia, visual field defects, sensory loss, ataxia and vertigo for 24 hours

Answer 6

Stroke (CT scan to see if ischaemic or haemorrhagic)

Question 7

Patient taking oral anticoagulants has limb and facial weakness down one side, dysphasia, visual field defects, sensory loss, ataxia and vertigo for 24 hours

Answer 7

Suspect haemorrhagic stroke until proven otherwise

Question 8

Gradually worsened altered consciousness, headache and N+V. Unequal pupil size and impaired vision with muscle weakness, slurred speech and ataxia

Answer 8

Haemorrhagic stroke (prove with CT scan)

Question 9

Occipital thunderclap headache. Positive Kernig and Bridzinski sign, low GCS score and nerve palsy in CN 3 and 6

Answer 9

Subarachnoid haemorrhage

Question 10

Gradual onset of bradycardia, widened pulse pressure, irregular breathing, low GCS, papilledema and headache. Previously fell down stairs.

Answer 10

Subdural haemorrhage
(suBdural = Banana shaped on CT scan)

Question 11

20 year old presents with gradual onset of headache, bradycardia, widened pulse pressure, irregular breathing and low GCS and papilledema following a transient loss of consciousness during a rugby match. The patient is becoming less conscious again.

Answer 11

Extradural haemorrhage

Question 12

A 40 y/o male presents with crescendo unilateral periorbital pain for the fifth time. You notice his eye and nose are runny and eyelid is droopy. He has a history of smoking, symptoms began after a pint.

Answer 12

Cluster headache

Question 13

20 y/o project manager presents with bilateral generalised headaches that radiate down the neck. Describes as feeling like a “rubber band around my head”

Answer 13

Tension headache

Question 14

30 y/o lady presents with recurrent throbbing headache on one side for 10 hours. She describes feeling motion sick and has been vomiting.

Husband comments about her irritability the day before. She is on the oral contraceptive.

Answer 14

Migraine without aura

Question 15

30 y/o lady presents with recurrent throbbing headache on one side for 10 hours. She describes being very tired a few days before headache and very blurred vision with flashing lights prior to the headache.
She describes preferring to lie in a dark room.

Answer 15

Migraine with an aura

Question 16

30 y/o lady present with very blurred vision, seeing zig-zags, hallucinations and seeing flashing lights.

Answer 16

Silent migraine
Aura without headache

Question 17

Female student presents with limb weakness on one side, impaired consciousness and loss of co-ordination. Her friends describe her recent irritability and the student describes seeing zig-zags.

Answer 17

Hemiplegic migraine (can mimic stroke or TIA so exclude these first)

Question 18

68 y/o lady presents complaining of an episode of electric-shock type pain across her cheek on one side which came on after eating her dinner. Lasted for 1 minute. This is the 3rd time this shooting pain has occurred.
Medical history shows diagnosis of MS.

Answer 18

Trigeminal neuralgia

Question 19

65 y/o male slowly shuffles into the room. As he describes his lacking sense of smell and his constipation, you notice his syllabic speech and it looks like he is rolling something between his fingers. He doesn’t seem to remember when his wife is coming to pick him up.

He has never smoked and although he drinks from time-to-time, this doesn’t improve his tremor.

Answer 19

Parkinson’s disease

Question 20

30 y/o male presents with trouble moving his eye to the side (CN 6 palsy). He also describes being tired all the time.
When you examining, you discover bradycardia, irregular breathing, a widened pulse pressure and papilledema

Answer 20

Primary brain tumour

Question 21

70 y/o lady comes into clinic with her daughter. You notice her daughter passing her a walking stick and the mother looking confused, not recognising what it is. She also struggles to get up out of her chair. When in a private room, the lady has slight difficulty speaking when explaining that her daughter thinks her memory has gradually got a worse.

Answer 21

Alzheimer’s

Question 22

A 70 y/o man with chronic hypertension and history of a stroke shuffles into the room. You know him well and he seems grumpier than he used to be. He describes going to the loo more frequently and is very agitated by this. He struggles to recall what he drank this morning.

Answer 22

Vascular dementia

Question 23

A 20 y/o lady presents with a history of irritability followed by feeling intense Deja vu. The next thing she remembers is being on the floor with a bleeding tongue and a headache. She seems confused and has no idea what happened.

Answer 23

Epilepsy

Question 24

35 y/o man falls on the floor and seems very rigid before a period of jerking limbs and incontinence for 2 minutes. He doesn’t remember it happening.

Answer 24

Tonic-clonic epileptic seizure

Question 25

35 y/o man has uncontrollable muscle jerking whilst being conscious and aware the whole minute this takes place.

Answer 25

Simple focal seizure (symptoms localized to functions of specific region of brain, fully aware and conscious.)

Question 26

40 y/o lady describes episodes of intense Deja vu followed by a sense of detachment from her surroundings. She then fidgets with her hands simultaneously with chewing motions. These least 2 minutes before gradually regaining full awareness. She then feels tired and confused.

Answer 26

Complex temporal focal seizure

(Altered consciousness, automatisms, cognitive symptoms, 1-2 mins, fatigue)

Question 27

40 y/o man present with episodes of twitching movement on his right side starting from his fingers up to his face, with repetitive swallowing and intense anger and irritability. He becomes confused and disorientated. These symptoms last for 2 minutes before feeling very hazy about what happened.

Answer 27

Frontal lobe complex focal seizure

Question 28

A 65 y/o lady presents with intermittent jaw pain on the left side with recent transient vision loss in her left eye. She describes also having a headache on the left side with a tender scalp.
She has a history of polymyalgia rheumatica

Answer 28

Giant cell arteritis

Question 29

A 40 y/o male presents with involuntary random limb movements. You notice his abnormal posture and slight speech difficulty. He mentions finding it harder to swallow food and how his wife says he has become moodier.
On testing, you find he has increased resistance to passive movement of joints.

Answer 29

Huntington’s

Question 30

A 25 y/o female presents saying how last week she had reduced vision in her left eye and pain with eye movement. She couldn’t see the colour red as well. She describes this worsening after taking a shower and how sometimes she couldn’t move her legs when she wants to move.
This week it has improved again but she is concerned something is wrong.

Answer 30

Multiple sclerosis

Question 31

A 30 y/o woman complains of numbness and tingling in her right hand and arm that has worsened recently. She has occasional episodes of blurred vision in her left eye and mild difficulty walking which she attributes to clumsiness. When her neck is flexed, she experiences an electric shock sensation. She also exhibits a mild intention tremor on finger-to-nose testing. No evidence of papilledema.

Answer 31

Multiple sclerosis

Question 32

50 y/o man presents with muscle twitching but sensory function is good. He describes choking on food more often and difficulty chewing.
Has positive Babinski sign but his eye muscles are not affected.

Answer 32

Motor neuron disease

Question 33

A 20 y/o male student presents with a headache, fever and headache. He has a non-blanching purpuric rash and positive Kernig and Brudzinski sign.

Answer 33

Meningitis caused by Neisseria Meningitidis

Question 34

2 y/o boy comes in with altered consciousness, a fever, headache and acute onset of focal seizures. You see he has cold sores and seems agitated.

Answer 34

Encephalitis

Question 35

55 y/o male presents with leg weakness that is getting worse and numbness in his feet which gets worse with movement. He states recently being occasionally incontinence. On examination he shows spasticity, hyperreflexia and sensory deficits below the umbilicus.

Answer 35

Myelopathy secondary to spinal cord compression (take MRI of spinal cord to confirm)

Question 36

45 y/o man presents with sudden onset severe low back pain, bilateral leg weakness and urinary retention. Upon asking, she has numbness in the saddle area. You find she has no ankle reflex.

Answer 36

Cauda equina syndrome (from MRI, needs urgent surgical decompression)

Question 37

A 50 y/o lady presents with an ache in her left hand and weakened grip. You notice wasting of her left thenar eminence.
You ask her to flex her wrist for 1 minute and she describes pain. When you tap on her wrist, she describes tingling sensation.

Answer 37

Carpal tunnel syndrome

Question 38

A 40 y/o man presents with wrist drop

Answer 38

Radial nerve palsy

Question 39

A 60 y/o woman presents with a claw hand (4th and 5th fingers are flexed)

Answer 39

Ulnar nerve palsy

Question 40

A 55 y/o woman complains of pain from her buttock down the side of her leg all the way to her little toe.
Upon examination, has has no ankle jerk and weak plantarflexion.

Answer 40

Sciatica