Danil Hammoudi.MD

SINOE MEDICAL ASSOCIATION

 

 

GENERAL NEUROLOGY PEARLS

 

 

*** L4

 

*** CORTICOBULBAR FIBERS BILATERALLY

 

 

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

EXEPT : THALAMUS

 

*** FLEXORS ARMS, EXTENSOR LEG

 

*** SCANING SPEECH

 

*** PERIOSTEUM, BLOOD VESSELS, MUSCLES CERVICAL

 

*** APHASIA

 

*** DAMAGE IN THE CEREBELLUM

 

*** MUSCLE FASCICULATION

 

*** CONTRALATERAL LESION PARALYSIS

 

*** INDIVIDUAL ATROPHY

 

*** MAMILLARY BODY’S

 

*** AREA POST TREMA

 

*** BRUZINSKI

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

*** BABINSKI, ROSSOLIMO, CHADOC GORDON, TROMNER

 

*** CENTRAL PONTINE MYELINOLYSIS

***MARCHIAFAVA BIGNAMI DISEASE

*** ADRENOLEUKODYSTROPHY

*** MULTIPLE SCLEROSIS

*** PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY [PML]

 

*** SPINOTHALAMIC TRACT

 

*** MENINGIOMA

 

*** PONTINE TEGMENTUM

 

*** PRECENTRAL GYRUS

 

 

*** BRODMAN 4

 

 

****

 

*** OBLIGUS SUPERIOR

 

 

 

*** PYRAMIDAL SIGNS

 

*** LESION IN THE VENTRAL TEGMENTAL AREA

 

 

 

*** OPTIC RADIATION

 

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

 

 

*** STRATUM  GANGLIONARE

 

*** THE PONS OF THE RIGHT SIDE

 

 

*** TRIGEMINAL LEMNISCUS

 

*** reserpine

 

 

 

 

 

 

*** posterior inferior cerebellar artery

 

*** cerebellum

 

*** parkinson’s disease

 

 

*** brodman  area 41

 

*** ape hand

 

***horner’s syndrome present

 

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

 

***pontine lesion

 

*** microglia

 

 

***peroneal nerve

 

***parietal lobe

 

***trigeminal motor nucleus

 

Double vision may associate with all of the following except:

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:

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:

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

Pontine Syndromes

·         Pontine Ventral

·         Pontine Dorsal

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