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Biology > WHat to learn from neuroanatomy cases that I dont know. > Flashcards

WHat to learn from neuroanatomy cases that I dont know. Flashcards

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1
Q

What is the diagnosis?

0 Initial – bilateral hearing loss – no tinnitus, headache, ototoxic drugs, excessive noise

0 Stated deafness; no response to verbal commands

0 No startle or responses to sounds in environment

0 Understood written commands

0 Left homonymous heminanopia

0 Asterognosis left hand

0 Mild left spastic hemiparesis

0 History

03 yrs previous – hemiparesis, slight loss sensation right side, receptive aphasia; recovery except for mild Wernicke’s aphasia

0 Progression

0perceived loud noises, and then normal hearing levels

0 Voices and sounds uninterpretable as language or particular sounds

A

THis person had two strokes in different places

-had an old lesion 3 years prior, of Left MCA stroke

and now a new one to Right Lenticulostriate/ antichoridal artery

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2
Q

What is the diagnosis?

0Chronic right leg pain 6 mo duration

0Intermittent, in buttock relieved by lying down

04 mo ago, painful tingling inside of right leg and top of foot

0Difficulty walking when right limb weight bearing

0Bending or lifting objects pain worse right leg and foot

0Right SI joint tender to palpation and paraspinals L4,L5

0Medial right leg and dorsum right foot decreased pain sense

0Difficulty heel walking right foot

0Positive Trendelenberg when raising left leg

0Ability to supinate right foot diminished

0Pain to raised or crossed leg tests

A

Person has a hernia disc most likely at L4-L5.

Has a radiculopathy (at the L5 nerve root

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3
Q

What is the diagnosis?

History of hypertension, hypercholesterolemia

Sudden diplopia

Gait unsteadiness

Staggering to the RIGHT

RIGHT hand clumsiness

LEFT eye down and out

LEFT ptosis

LEFT mydriasis

LEFT eye unresponsive to light

RIGHT ataxia as shown by the finger-to-nose and heel-to-shin tests

A

Claud Syndrome of the Midbrain

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4
Q

What are the signs of the claude midbrain syndrome?

A

Brainstem stroke characterized by:

¡Ipsilateral Oculomotor Nerve Palsy

¡Contralateral Ataxia

Contralateral Hemiplagia of the lower face, tongue, shoulder (If involves corticobulbar and corticospinal tracts of the crus cerebri)

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5
Q

What is the diagnosis?

0 progressive gait unsteadiness

0 memory problems

0 incontinence

0 Over a period of past 3-4 months

0 No cranial nerve signs/vision losses

A

Normal Pressure Hydrocephalus

(Wet, wacky, wobbly)

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6
Q

What is normal pressure hydrocephalus characterized by? (signs)

A

Age greater than 60

Wet (Incontinence)

Wacky (memory problems or dementive)

Wobbly (Gait unsteadiness)

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7
Q

What is the diagnosis?

0 Voice lower in volume and pitch, hoarse

0 Shortness of breath – flaccid dysphonia

0 Mild inspiratory stridor

0 Respiration low normal

0 Swallowing OK, Cough OK, Gag OK

0 History

0 Lung tumor

A

Peripheral Nerve Lesion to Vagus Nerve

specifically the Recurrent Laryngeal Nerve

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8
Q

Injury to larygneal recurrent nerve causes what symptoms?

A

Hoarseness

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9
Q

What is the diagnosis?

0 Diabetes insipidus

0 Overweight

0 Low libido

0 Bitemporal heminaopia

A

Pituitary Tumor pressing on the Optic Chiasm

(buzz word: Bitemporal hemopia)

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10
Q

What is the diagnosis?

0 Convulsion, stuporous but recovered in one hour

0 Headaches

0 Changed personality, never completes things

0 Broca’s aphasia

0 Right lower face paralysis

0 Tongue protrudes to right

0 Sensory loss right face, right arm?

0 Right arm weakness

0 Progression:

0 Over a few days – personality changes, akinetic mutism

0 Weakness spread right leg, other side of body

0 Difficult to map sensory loss

0 Pupils dilated, (left more than right), papilledema

0 Coma and died

A

Glialblastoma

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11
Q

commons buzzword symptoms of Glialblastoma

A

symptoms: headaches, nausea, vomiting and seizures

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12
Q

What is the diagnosis?

0 Broad-based gait, leg ataxia – hypotonia on left

0 Decreased pain and temperature on left side of face

0 Corneal reflex lost on left

0 Paralysis muscles of facial expression on left

0 Hearing loss in left ear

0 No gag reflex on left side oropharynx

0 Sensory OK for body, epicritic OK for the face

A

Acoustic Schwannaoma

Slow-growingtumor , acoustic neuroma

External to brainstem

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13
Q

What are the symptoms for acoustic schwannoma?

A

Hearing loss, usually gradual — although in some cases sudden — and occurring on only one side or more pronounced on one side

Ringing (tinnitus) in the affected ear

Unsteadiness, loss of balance

Dizziness (vertigo)

Facial numbness and very rarely, weakness

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14
Q

What is the diagnosis?

A 50-year old attorney, who regularly smokes one pack of cigarettes a day, had been diagnosed with hypertension but kept forgetting to take his blood pressure medications.

Problems List

0 Several episodes of blurred vision “like a shade over eyes”

0 Severe left sided headache

0 Loss of vision in left eye

0 Confused, uncommunicative

0 Right sided paralysis- arm, leg, lower half of face

0 Babinski on right

0 Global aphasia-

0 unable to produce intelligible speech

0 only understand a few phrases

A

Left Internal Carotid Infarction

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15
Q

SYmptoms of Internal Carotid Infarction

A

Sudden loss of vision, blurred vision, or difficulty in seeing out of one or both eyes

Weakness, tingling, or numbness on one side of the face, one side of the body, or in one arm or leg

Difficulty speaking (called aphasia)

Confusion

Sudden severe head

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16
Q

What is the diagnosis of this patient?

0 Headaches and vomiting (not always together) – papilledema bilaterally

0 Unsteady, staggering to the right, wide-based gait – ataxia

0 Right hand clumsy – intention tremor, dysdiadochokinesia

0 Horizontal nystagmus during voluntary eye movement (saccades)

0 Romberg right side, eyes open or closed

A

Cerebellar Tumor

17
Q

What is the diagnosis of this patient?

0 Speech slurred and constant fidgeting

0 Involuntary tongue movements

0 Absent-minded

0 Family history

0 Progression

0 Severe memory loss

0 Involuntary tongue and limb movements

A

Huntingtons (Huntington’s disease)

18
Q

Huntington’s disease buzz words

A
  • involuntary movement
  • family history
  • Involuntary tongue and limb movements
19
Q

What is the diagnosis?

0Bungee collision – Flaccid paralysis and no feeling below C8 or so

0 Progression

0 Loss of pinprick and temperature left side below T2

0 Loss of epicritic sense right side at and below C8

0 Complete anesthesia C8 right side

0 Weakness right forearm and hand and fasciculations medially (little finger side)

0 Hyporeflexia wrist and fingers

0 Hyperreflexia knee and ankle on right

0 Babinski right side

0 Left side motor normal

0 Horner’s syndrome right side

A

Spinal Cord Hemi-section:

Brown- Sequard Syndrome

20
Q

Brown-Sequard Syndrome (SC hemi-section buzzwords)

A
  • Collision or trauma accident
  • loss of protopathic on contralateral side and epicritic on ipsilateral side
21
Q

What is the diagnosis?

0 Nauseous and Dizzy

0 Nystagmus

0 Ataxia of right limbs

0 Voice is hoarse, difficulty swallowing

0 Reduced pain and temperature on right side of face

0 Horner’s syndrome in right eye

A

Lateral Medullary Syndrome (Wallenburg syndrome)

22
Q

Lateral Medullary Syndrome (wallenburg syndrome) hints

A

-multiple symptoms involving Nucleus Ambiguous, spinal of CN 5, HRST, and cerebellar symptoms. (should lead you to think brainstem)

23
Q

What is it the diagnosis?

0Collapsed, hypertension

0 Left lower quadranopia

0 Left lower face paralysis

0 Tongue deviation to left

0 Paresis and hyperreflexia of left arm and thigh

0 Left visual neglect, and neglect left side of body

0 Somatosensory loss (partial recovery) left face, arm, thigh

A

stroke of the Right Middle cerebral artery with contralateral hemineglect

24
Q

What are buzz words for MCA stroke?

A
  • hypertension or CAD (should make you think vascular)
  • If on the Left: Global aphasia or Broca or wernicke aphasia
  • If on Right: heminieglect of left side
25
Q

What is the diagnosis?

0 Burned hand – said no feeling in hands

0 Slight reduction in arm strength bilaterally and hyporeflexia at elbow and wrist

0 Fasciculations intrinsic muscles hands

0 Loss pain and temperature dorsum hands, but epicritic normal

0 Progression

0 Strength in both arms reduced

0 Areflexic at elbow and wrist

0 Fasciculations and atrophy bilaterally

0 Hyperrelexia and paresis in legs

0 Pain and temperature loss cape-like distribution to fingertips

0 Epricritic normal

A
  • syringomyelia
26
Q

What are buzz phrases for syringomyleia?

A
  • abnormal sensations and loss of sensation particularly in the hands.
  • Loss of protopathic sensation at the dermatomal distribution
  • muscle weakness in both sides of the body
  • Also if you have indications that there is lesion at the anterior commissure (for example: loss of ipsilateral epicritic sensation and contralateral loss of protopathic at the same time)
27
Q

What is the diagnosis? WHy is this one different?

Ptosis (lid droop) and Mydriasis (pupillary dilation) right eye

External strabismus right, not move past midline looking to left

Left lower facial paralysis

Left tongue deviation

Left paresis – hyper-reflexia, Babinski left side

A

Lesion of the Stroke of the Basilar artery, PCA, Posterior Communicating artery. (Webber Syndrome)

-its different because you have motor deficit involvment and Oculomotor signs, and Facial upper motor neuron deficit suggesting possible stroke at the midbrain in crus cerebri area.

28
Q

Symptoms of Webber Syndrome

A
  • ipsilateral Oculomotor Palsy
  • contralateral paresis of motor (corticalspinal tract involvment)
29
Q

What is the diagnosis?

0Brief loss of consciousness

0Severe headaches over past day

0LEFT leg was “clumsy”

0Dizziness; loud roaring sound in LEFT ear

0History of HTN, heavy smoking and drinking

0Horizontal nystagmus (RIGHT beating)

0Diminished hearing in LEFT ear

0Vertigo

0Protopathic losses to LEFT face and somewhat diminished on RIGHT

0Absent protopathic sense on RIGHT body

0Absent corneal reflex on LEFT and weak on RIGHT

0LEFT sided facial paralysis

0Diminished tone in LEFT limbs

0Abnormal cerebellar testing on LEFT

0Ataxia in LEFT limbs

0Dysmetria, (+) Finger to Nose, (+) Heel to Shin

A

Stroke of AICA

30
Q

Stroke of AICA buzz words

A
  • symptoms of facial, trigem, vestibular and cerebellar
31
Q

What is the diagnosis?

0 transient vision loss in “right eye”

0 severe retro orbital headache

0 persistent right homonymous hemianopsia as of 2 days ago

0 alexia

0 could identify other objects,faces,etc

A

Left PCA stroke

(remember below the optic chiasm everything below the chiasm will be visual field issues opposite the lesion)

32
Q

buzz words for PCA stroke

A
  • visual field loss (CN2 defect at optic tract or lower)
  • CAD, hyptension history (make you think vascular)
  • look for symptoms of other areas represented in PCA stroke such as if left: speech and language deficits and if right: left hemineglect
33
Q

What is the diagnosis?

0 Collapsed, hypertensive, overweight, stressed, smoked

0 Right flaccid paralysis

0 Dysarthria

0 Right epicritic sense loss

0 Tongue deviates to left

0 Progression:

0 Tongue deviates left, wrinkled, fasciculations

0 Hyperreflexia, paresis right side

0 Babinski right side

0 Sensory loss remains

A

Medial Medullary Syndrome

34
Q

What are the symptoms of Medial Medullary Syndrome?

A

Contralateral hemiparesis

Contralateral epicritic deficits

Ipsilateral paralysis of tongue muscles (CN 11) with deviation to side of lesion.

*Look for stroke onset too.

35
Q

Buzz word for Pinealoma

symptoms

A
  • unable to look up
  • Oculomotor problems

*symptoms are:

–Loss of pupillary eye and accommodation reflexes (Pretectal Area)

–Paralysis of upward gaze (Vertical Gaze Center (Interstitial Nucleus of Cajal), Posterior Commissure)

–Increased Intracranial Pressure/Hydrocephalus (Cerebral Aqueduct)

36
Q

What is the diagnosis?

0 Collapsed removing bread, unconscious a few minutes

0 Large scotomas bilaterally

0 Arms and legs epicritic and protopathic sense diminished

0 Anterograde amnesia

0 Dropped objects when held

A

Stroke at top of the basilar artery

37
Q

Top of the Basilar artery syndrome is characterized by buzz words:

A
  • visual and oculomotor deficits bilaterally
  • arms and leg loss of both epicritic and protopathic sensation.
38
Q

WHat is the diagnosis?

0 acute gait imbalance

0 lean to the right

0mild headache

0 right pupil smaller than the left with ptosis in the right eye

0 gaze induced, right-beating nystagmus when asked to look to the right, more so in the right eye than the left eye

0 diminished sensation to pinprick on the left side of the face and body

0 ataxia, hypotonia, dysmetria and intention tremor in the right limbs

0 deviated to the right when walking

A

Superior Cerebellar Artery Stroke

Biology (10 decks)

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