Danil Hammoudi.MD

SINOE MEDICAL ASSOCIATION

GENERAL NEUROLOGY PEARLS

• Which segment is involved in the knee jerk:

*** L4

• Pseudobulbar paresis may result from a damage to the:

*** CORTICOBULBAR FIBERS BILATERALLY

• Muscle hypotonia would be expected in a damage to structures :

*** PERIPHERAL NERVE, CERBELLUM, LOWER MOTONEURON, VENTRAL HORN OF THE SPINAL CORD

EXEPT : THALAMUS

• Characteristic features of spasticity - the muscle tone is increased

*** FLEXORS ARMS, EXTENSOR LEG

• Which of the following speech disturbance would be expected in a damage to the cerebellum

*** SCANING SPEECH

• structures are sensitive to pain :

*** PERIOSTEUM, BLOOD VESSELS, MUSCLES CERVICAL

• Which of the following is not a clinical symptom of cerebellar damage:

*** APHASIA

• What causes intention tremor

*** DAMAGE IN THE CEREBELLUM

• Which of the following is not indicative of a damage to the pyramidal tract

*** MUSCLE FASCICULATION

• Which of the following is not characteristic of the Brown-Sequard syndrome

*** CONTRALATERAL LESION PARALYSIS

• Which is not characteristic of the upper motor neuron lesion:

*** INDIVIDUAL ATROPHY

• Korsakoff's syndrome is the result of damage to the

*** MAMILLARY BODY’S

• Which part of the brain controls vomiting?

*** AREA POST TREMA

• Which of the following signs is not indicative of a damage to the pyramidal tract

*** BRUZINSKI

Which of the following signs is indicative of a damage to the pyramidal tract

*** BABINSKI, ROSSOLIMO, CHADOC GORDON, TROMNER

• Demyelination is a feature of all the following

*** CENTRAL PONTINE MYELINOLYSIS

***MARCHIAFAVA BIGNAMI DISEASE

*** ADRENOLEUKODYSTROPHY

*** MULTIPLE SCLEROSIS

*** PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY [PML]

• Which of the following does not participate in regulation of the muscle tone:

*** SPINOTHALAMIC TRACT

• Human immunodeficiency virus infection may be associated with :

*** MENINGIOMA

• In the pathway of the pyramidal tract, the axons project through all of the following

*** PONTINE TEGMENTUM

• Where is the primary motor cortex:

*** PRECENTRAL GYRUS

• The primary motor cortex corresponds to the area:

*** BRODMAN 4

• Characteristic signs of conus medullaris syndrome include except:

**** A. pyramidal signs B. sphincter dysfunction C. perineal sensory deficit D. symmetric neurological signs E. loss of anal reflex F. sexual dysfunction

• Which of the following muscle is supplied by the trochlear nerve

*** OBLIGUS SUPERIOR

• The contents of the superior orbital fissure include except:

A. oculomotor nerve B. abducent nerve C. facial nerve D. trochlear nerve E. ophthalmic nerve F. -

• Which of the following is not a feature of the cauda equina syndrome

*** PYRAMIDAL SIGNS

• All of the following may be the anatomical basis of spastic paraparesist involving legs

*** LESION IN THE VENTRAL TEGMENTAL AREA

• Which is not a clinical symptom of the Jakob-Creutzfeldt disease:

A. myoclonus B. dementia C. hyperkinesis D. epileptic seizures E. ataxia F. pyramidal signs

• The pathway for the pupillary light reflex does not involve

*** OPTIC RADIATION

• Damage to the right frontal eye field (Brodman 8) results in which of the following:

*** BOTH EYES ARE DEVIATED TO THE RIGHT AT REST

• A lesion of the right frontal lobe will result in all of the following except:

A. left sided hemiparesis B. pyramidal signs on the left side C. gaze paralysis to the right D. eyes will look away from the paralyzed left limbs E. gaze paralysis to the left F. adversion of the head to the right

• The Purkinje cells can be found in the

*** STRATUM GANGLIONARE

• Which of the following is damaged in a case of left sided hemiparesis associated with a gaze paralysis to the right:

*** THE PONS OF THE RIGHT SIDE

• All of the following deficits might occur with a facial nerve palsy except:

A. dry eyes B. weakness of the muscles of facial expression C. loss of taste to anterior 2/3rds of tongue D. hyperacusis E. weakness of the temporal muscle F. -

• The principal ascending auditory pathway of the brainstem is the :

*** TRIGEMINAL LEMNISCUS

• A long lasting depletion of norepinephrine can be produced by administration of:

*** reserpine

• A lesion to the following structures results in hemiparesis except:

A. frontal lobe B. parietal lobe C. internal capsule D. cervical spinal cord E. Brodman 4 area F. precentral gyrus

• All of the following are superficial reflexes except:

A. flexor plantar reflex B. abdominal reflexes C. conjunctival reflex D. cremasteric reflex E. masseter reflex F. -

• Hypotonic hyperkinetic syndromes include except:

A. ballism B. intention tremor C. chorea D. athetosis E. myoclonus F. -

• Which of the following does not result from a lesion of the cerebellum:

A. dysdiadochokinesis B. muscle hypotonia C. dysmetria D. tremor at rest E. intention tremor F. trunk ataxia

• Frontal release signs include all of the following except:

A. sucking reflex B. pronator drift C. palmar grasp reflex D. glabellar reflex E. snout reflex F. -

• Which structure is affected in Huntington's chorea:

A. pallidum B. amygdala C. archistriatum D. neostriatum E. hippocampus F. thalamus

• The decussation of the corticospinal tracts occurs:

A. in the internal capsule B. near the caudal extremity of the medulla oblongata C. above the sensory decussation D. a praemotoros area károsodása E. in the ventral pons F. in the ventral funiculus of the spinal cord

• Which of the following is true of the nuclei of the facial nerve:

A. shares nucleus ambiguus with cranial nerves IX and X B. motor nucleus is located in the upper pons C. parasympathetic nucleus is the inferior salivatory nucleus D. sensory nucleus is represented by the spinal trigeminal nucleus E. none of the above F. all of the above

• A lateral medullary syndrome (Wallenberg) might result from occlusion of the:

*** posterior inferior cerebellar artery

• Rebound phenomenon (Holmes's sign) might associate with the damage to the:

*** cerebellum

• Cog-wheel rigidity can be found in:

*** parkinson’s disease

• Pathological hallmarks of Alzheimer's diseases includeall of the following except:

A. amyloid deposition in neuritic plaques B. parieto-temporal atrophy C. Lewy body D. neurofibrillary tangles E. senile plaques F. neuronal loss

• Broca's (nonfluent, expressive) aphasia results from a damage to the:

*** brodman area 41

• Which is not characteristic of radial nerve lesion

*** ape hand

• Which of the following statement is not true regarding the upper plexus brachialis lesion (Erb-Duchenne):

***horner’s syndrome present

• Which of the following statement is not true regarding oculo-cephalic reflex (doll's eyes):

***brain stem intact eye follow direction of head rotation

• Bilateral pinpoints pupils suggest:

***pontine lesion

• Which of the following cell type is not ectodermal in origin

*** microglia

• Microscopical characteristics of viral encephalitis include except:

A. in subacute forms: astrocytosis B. presence of Hirano bodies C. neuronophagia D. microglial nodules E. perivascular cuffs of lymphocytes F. none of the above

• "Steppage gait" may assoctiate with the injury of the:

***peroneal nerve

• Where is the primary sensory cortex located

***parietal lobe

• Which of the following cranial nerve nuclei is not found in the upper medulla:

***trigeminal motor nucleus

Double vision may associate with all of the following except:

A. Jakob-Creutzfeldt disease B. Wernicke encephalopathy C. brainstem stroke D. myasthenia gravis E. multiple sclerosis F. metabolic ocular myopathy

How can we elicit the Chaddock sign:

*** stroking the lateral side of the foot beneath lateral malleolus

Foster-Kennedy syndrome is characterized by all of the following except:

A. ipsilateral anosmia B. contralateral papilledema C. ipsilateral papilledema D. ipsilateral optic atrophy E. raised intracranial pressure F. headache

Damage to which structures may cause Benedikt syndrome

***red nucleus, nucleus of the oculomotor nerve

Ophthalmoplegia is a characteristic feature in all of the following except:

A. Gradenigo syndrome B. Nothnagel syndrome C. Millard-Gubler syndrome D. Benedikt syndrome E. Weber syndrome F. Foville syndrome

Millard-Gubler syndrome

Lesion in the ventral pons affecting the corticospinal tract before its decussation, and the VI nerve on its way out of the Pons

• Ipsilateral VI Palsy
• Contralateral Pyramidal weakness
• Variable signs of a dorsal pontine lesion

Pontine Syndromes

· Pontine Ventral

• Millard Gubler – corticospinal, VI, VII,
• Raymond – corticospinal, VI fascicles

· Pontine Dorsal

• Foville Syndrome – corticospinal, VII, PPRF

Crossed brainstem syndromes

Syndrome	Site of lesion	Ipsilateral side	Contralateral side
Weber (hemiparesis alternans oculomotoria)		Oculomotor palsy	Hemiparesis
Benedikt		Oculomotor palsy	Hyperkinesis (athetosis,chorea) Rigor Disturbance of deep sensibility
Raymond-Cestan	oral pons	Internuclear ophthalmoplegia	Hemiparesis Ataxia Hypesthesia
Raymond (hemiparesis alternans abducens)		Abducent palsy	Hemiparesis
Millard-Gubler (hemiparesis alternans facialis)		Facial paresis	Hemiparesis
Brissaud-Siccard		Facial hemispasm	Hemiparesis
Foville		Facial paresis Abducent paresis Horizontal gaze paralysis	Hemiparesis
Avellis (hemiparesis alternans vaga)		Signs of vagus lesion	Hemiparesis
Schmidt (hemiparesis alternans accessoria)		Paresis of m. trapezius and m. sternocleidomastoideus	Hemiparesis
Jackson (hemiparesis alternans hypoglossa)		Hypoglossus palsy	Hemiparesis
Déjerine		Hypoglossus palsy	Hemiparesis Disturbance of deep sensibility

1A 45 year old male complained of a severe headache. He was noted on physical examination to have papilledema on the right. He then became obtunded and died. The gross pathologic finding seen here is most likely to have been produced as a consequence of:

A)	Ocular melanoma
B)	Berry aneurysm rupture
C)	Glioblastoma multiforme
D)	Multiple sclerosis
E)	Meningococcemia

*	1.	c
*	2.	d
*	3.	a
*	4.	a
*	5.	d
*	6.	b
*	7.	e
*	8.	c
*	9.	e
*	10.	b

2This microscopic appearance with trichrome stain demonstrates the findings in a 3 cm lesion from the right parietal lobe that was ring enhancing by CT scan. The patient, a 48 year old female, had headaches for several weeks and then presented to the emergency room with a grand mal seizure. The most likely diagnosis is:

A)	Glioblastoma multiforme
B)	Herpes simplex encephalitis
C)	Arteriovenous malformation
D)	Cerebral abscess
E)	Acute infarction

A 42 year old male has had increasing difficulty with activities of daily living for the past year, mainly because of choreiform movements. His family has also noted that he has exhibited behavioral changes, though his memory remains intact. His brother is similarly affected. Based upon the appearance of the coronal section of brain shown here, the disease most likely to explain these changes is:

A)	Huntington's disease
B)	Parkinson's disease
C)	Alzheimer's disease
D)	Amyotrophic lateral sclerosis
E)	Multiple sclerosis

This lesion appeared on CT scan as a discreet mass beneath the dura and was seen to compress the underlying cerebral hemisphere. The patient is a 45 year old female who presented with headaches for the past month. The best diagnosis is:

A)	Meningioma
B)	Astrocytoma, low grade
C)	Ependymoma
D)	Metastasis
E)	Tuberculoma

This 79 year old woman was driving her car when she had the sudden onset of a severe headache. She pulled in to a service station and stopped the car. Then she slumped over the wheel. She was taken to the emergency room, where she remained comatose and died hours later. The most likely explanation for the gross appearance seen here is:

A)	Glioblastoma multiforme
B)	Thromboembolization with cerebral infarction
C)	Multiple sclerosis
D)	Ruptured berry aneurysm
E)	Huntington's disease

A 60 year old male has the lesion shown here at autopsy. He had suddenly lost consciousness, and when he again became alert, he was unable to move his left arm or speak. Which of the following underlying disease processes is he most likely to have to explain these findings:

A)	Hypertension with chronic renal failure
B)	Rheumatic heart disease with left atrial mural thrombosis
C)	Chronic alcoholism with micronodular cirrhosis
D)	Acquired immunodeficiency syndrome with low CD4 count
E)	Papillary thyroid carcinoma with metastases to bone

A 20 year old male has a severe headache, present for about a day. Physical examination reveals nuchal rigidity. His vital signs reveal a temperature of 38.8 C, respirations 26, pulse 98, and blood pressure 95/45. The gross appearance of the surface of the brain is shown here. Which of the following organisms is most likely to be responsible for these findings:

A)	Cryptococcus neoformans
B)	Mycobacterium tuberculosis
C)	Toxoplasma gondii
D)	JC Papovavirus
E)	Neisseria meningitidis

For the past year, a 34 year old woman has been treated with high dose immunosuppressive therapy, including prednisone and cytoxan, for high grade lupus nephritis. She now presents with increasing headache and decreased mentation for about a week. A complete blood count reveals that her WBC count is markedly decreased. Based upon the microscopic appearance of the lesion seen here with Gomori methenamine silver stain, the most likely explanation for these findings is:

A)	Progressive multifocal leukoencephalopathy
B)	Multiple sclerosis
C)	Aspergillosis
D)	Herpes simplex encephalitis
E)	Cryptococcosis

A 28 year old previously healthy male has the onset of seizures that continue for several weeks. A head CT scan reveals a mass lesion with surrounding hemorrhage in the right cerebral hemisphere. A sterotactic biopsy is performed, and the high power microscopic appearance of the lesion is shown here. The most probable diagnosis is:

A)	Organizing cerebral abscess
B)	Herpes simplex encephalitis
C)	Berry aneurysm
D)	Glioblastoma multiforme
E)	Vascular malformation

A 75 year old female has had progressively worsening mental function, as indicated by her son when he brings his mother to see you. The son states that his mother is now frequently getting lost in the neighborhood. He relates that she cannot easily feed or dress herself. She often does not seem to know who he his. After a year-long course in a nursing home, she dies from a respiratory infection. The brain at autopsy weighs 1025 gm and demonstrates frontal and parietal atrophy, with ex vacuo ventricular dilation. The light microscopic appearance of the frontal cortex is seen here with Bielschowsky silver stain. Which of the following statements best characterizes this process:

A)	A bloodborne pathogen led to this illness
B)	An amyloid angiopathy can be present
C)	Inheritance of this disease occurs in an autosomal dominant fashion
D)	A response to dopaminergic pharmacologic agents is often observed
E)	Aluminum toxicity can explain these findings