Vascular and Motor Lesions

Question 1

vestibular shwanomma case

Answer 1

slow onset of loss of hearing, balance issues, nystagmus, headaches

MRI-tumor at cerebellopontine angle

1st surgery didn’t decrease size

2nd surgery caused a facial nerve palsy

Question 2

Epidural Hematoma

Answer 2

hx of head injury

can be abusive, combative, semi-comatose in ED

fracture in temporal bone or pterion

can lead to cerebral edema, herniation and death

lens look on CT

Question 3

Chronic subdural hematoma

Answer 3

exertional headaches after injury

progressively worsens

worsens with positions, movement, may be some weakness, nausea and vomiting can lead to midline shift

cresent shape on CT

Question 4

Subarachnoid hematoma

Answer 4

“worst headache of my life” suddenly

LOC, nuchal rigidity, positive Kernig’s

normal Doll’s head (no brainstem involvement)

bloody CSF with increased pressure

Spider/web appearance on CT

Question 5

Anterior Paracentral Lobule/lobe intracerebral hemorrhage

Answer 5

sudden weakness in left leg

confusion/speech issues

flaccid paralysis on left leg

minimal weakness of left hand

left babinksi

CT hyperdense over the ACA area and watershed on Right

similar sx can appear with falx cerebri and lesser wing tumors

Question 6

Vertebral basilar insufficiency

Answer 6

can result from mandible fractures with cmpression of the transverse process of the atlas

can cause quadriplegia

Question 7

Lesion of Internal Capsule

Answer 7

hemianalgesia of pain and temp on left body and face

proprioception/2pt gone on left body and diminished on left face

left spastic hemiplegia and hyperreflexia w/ babinksi

weak facial muscles on left

left homonymous hemianopsia

R-internal capsule lesion(lenticulostriate A.)

Question 8

Frontal Lobe Syndrome

Answer 8

long onset of apathy

shuffling gait

incontinence

change in eating habits/anosmia

Question 9

Expressive/Broca’s Aphasia

fluent/pure/wernicke’s Aphasia

Answer 9

Brocas: specific disorder in which language, grammer and word choice are intact but difficult to produce, lots of um’s, slower speech, time spent searching for right word.

Wernickes: Quick, easy flowing speech, but makes no sense, random words, person seems to know exactly what they’re talking about, though

Question 10

Wernicke’s Aphasia

Answer 10

auditory agnosia

inability to comprehend the spoken or written word

aka paragramatical aphasia