Thursday, 8-25-Clinical Conference #7-Stephens Flashcards
a 46 yr old male heavy equipment operator came to the health clinic complaining of intermittent headaches associated with stress from his job. he has a hx of intermittent psychotic episodes during which he has bladder and bowel incontinence and had previously been a psych pt. each episode lasted 1-2 weeks
2 months prior to his visit, he notes difficulty in walking especially climbings stairs. The condition became progressively worse. At the clinic he collapsed on the floor and had a generalized seizure. Neuro exam revealed b/l weakness, spasticity, hyperreflexia, Babinski, and spastic gait. He exhibited disorganization of though and made many silly wisecracks during the exam.
Most likely Dx?
parasagittal meningioma-Anterior paracentral lobule and frontal lobe syndrome
Case 9252, p.83
a 73 yr old female is admitted with 4 week history of gait disturbance. She developed nonspecific dizziness 3 weeks prior to admission and diplopia on lateral gaze 1 week before exam. One day before she was nauseous and vomitting. The exam revealed:
1) Well developed and well-nourised, NAD
2) Dysmetria on right finger-to-nose and heel-to-shin testing
3) Difficulty with rapidly alternating movements on the right
4) wide-based gait
5) nystagmus on bilateral lateral gaze
6) b/l papilledema
CT confirmed a mass in right cerebellar hemisphere. Vomiting and diplopia relieved after operation and 4 months later had only minimal residual ataxia.
Most likely dx?
cerebellar medulloblastoma
Case 9256, p. 84
a 30 yr old saleswoman was examined by a neurologist and found the following:
1) inability to adduct either eye when testing for horizontal gaze
2) both eyes could adduct during convergence
3) there was a horizontal nystagmus only in the abducting eye when attempting to look to either the right or left
Most likely dx?
Intranuclear ophthalmaplegia; b/l lesion of MLF
Case 9236, p. 78
a 22 yr old male track athlete saw his doc for 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. 2 months later, his limbs continued to weaken until he could no longer walk. Exam at the time revealed spastic paralysis and increased patellar and achilles reflexes in both lower limbs. Babinski b/l.
Most likely dx?
Meningioma of falx cerebra compressing anterior paracentral lobule
Case 9247, p. 81
a 58 yr old male ad exec with a history of HTN collapsed in the parking lot of his building and brought to the hospital by ambulance. After he regained consciousness, exam revealed:
1) Sensory deficits –> hemianalgesia and thermal hemianesthesia on left side of body and face; slow pain sensations vaguely perceived on left side of body and face
2) spastic hemiplegia with hyperreflexia and babinski
3) inability to smile on left side
4) left homonymous hemianopsia
Most likely dx?
infarct of the right internal capsule
Case 9248, p. 81
80% of cortical infarcts occur here!
a 67 yr old male is brought to the hospital following acute head trauma. PMH given by his wife. Pt underwent personality change of past 12 yrs deteriorating more during the last 3 yrs. He developed progressive memory loss, esp short-term memory. Spontaneous movements and speech markedly reduced pt has a loss of bowel and bladder function. He was alert, but disoriented esp. with respect to time and place.
The exam revealed slow responses to ?s and simple commands with occasional incorrect responses. Naming, spelling, repetition were intact. He exhibited very little spontaneous behavior, no change in affect, and disinhibition of behavior. Pupillary responses and EOM were normal and no nystagmus. Optic discs flat and fund were pale. Other CNs normal. Path reflexes not present. He was unable to stand and walk without help. He had tenderness of skull over rt temporal region, rt periorbital hematoma, an no nuchal rigidity. Plain skull films revealed a rt temporal fracture. ACAs were depressed and displaced. Post-mortem findings included a giant aneurysm of ACoA.
Most likely Dx?
Frontal lobe syndrome
Case 9258, p. 85
APATHY is the HALLMARK
The __ is functionally an extension of the limbic lobe. It is involved in the regulation of depth of our feelings, the affective component of visceral and somatosensory sensations, motivation, and to some degree, personality.
prefrontal lobe
Prefrontal tumors, infarcts, or lobotomies may cause a pt to be:
easily distracted, unable to plan, tactless, extroverted, without emotional tensions, or released from inhibitions.. There is no change in intelligence
___ is characterized by apathy, occasional euphoria, abrupt irritability and socially inappropriate behavior
Frontal lobe syndrome
Case 9258, p. 85
Case 9249, p. 82
Case 9243, p. 80
a lesion in the __ may result in visual and auditory hallucinations and very clear recollections of past experiences. The pt may also have deja vu experiences or bizarre integrations of hallucinations of present reality with past experiences. The pt is cognizant, and often fearful, of these hallucinations.
Anterior temporal cortex
Case 9244, p. 80
___ is due to a lesion of the dominant parietal lobe. It is characterized by finger agnosia, right-left disorientation, dysgraphia and dyscalculia
Gerstmann syndrome
Case 9251, p. 82
__ may be due to a lesion of the supra marginal area in the dominant hemisphere. The pt may be unable to recognize, identify, or discriminate somatosensory (tactile), visual, auditory, smell, or taste information. Lesions in this area may also cause a ___ characterized by an inability to recognize common objects through general sensory cues
agnosia
cortical astereognosis
Case 9250, P. 82
large lesions in the ___ may result in a denial of body scheme or failure to recognize the body scheme on the opposite side
somesthetic association cortex (superior parietal lobule)
Case 9250, p.82
Lesions of the __ result in receptive aphasia, which may include alexia, visual agnosia (unable to read), or agraphia (unable to copy)
angular gyrus in the dominant hemisphere
Case 9250, p.82
Bilateral lesions of the __ result in disorientation of spatial discrimination, e.g., gropes or runs into “seen” objects.
angular gyri
Case 9250, p. 82
