Term
A patient presents with aphasia and right side muscle weakness.
What could be going on? |
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Definition
Left Brain lesion(s)
Aphasia is a language pathology so it is likely associated with the left Hemisphere in Broca's (speech production in inferior frontal gyrus) or Wernicke's area (comprehension in inferior superior temporal lobe).
Right side weakness could arise from a lesion along the corticospinal path in the left motor strip (crosses at pyramidal deccusation) |
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Term
A 61 year old patient prevents with a resting tremor of the left hand. He does not swing the eft arm when he walks, has reduced facial animation, blinks seldomly and has rigidity in the left arm as well.
What is going on? |
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Definition
| Sounds like Parkinonism (substantia nigra or striatum degeneration) |
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Term
A 46 year-old female has progressive difficulty ascending stairs and must pull herself with the handrail. She can't lift objects into kitchen cupboards and keeps her arms up in the air to fix her hair.
Exam reveals weakness in proximal muscles of arms and legs.
What is going on? |
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Definition
| Pattern in common in myopathy. |
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Term
A 22 year-old presents with disorientation and agitation, but without motor weakness or language-loss.
What is likely to be going on? |
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Definition
Sounds diffuse, without subcortical involvement of language-centers or motor tract.
Most likely an encephalopathy (entire cortex and underlying white matter) |
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Term
A 51 year-old who takes a diuretic for hypertension presents with generalized tonic-clonic convulsion.
He recovers and serum Na is 119 meq/li
What is going on? |
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Definition
This example exemplifies the point that mere localization of a site of dysfunction does not assume structural pathology at that same site.
Here there is cerebral cortex involvement, but with a generalized metabolic disorder cause (hypertension). |
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Term
Whenever a patient flexes their cervical spine, they experience what can only be described as an "electric shock."
What is going on? |
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Definition
This is Lhermitte's phenomenon and arises because of dorsal column dysfunction in the cervical region
(remember, this column synapses at nucleus gracilus and cuneatus, before crossing and traveling up the medial lemniscal pathway). |
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Term
| What type of neurological disorder causes a patient to either consistently contract or fail to relax their grip? |
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Definition
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Term
A 75 year-old man developed weakness of right arm and leg and slurring of speech. He also has difficulty seeing with his right eye.
Exam reveals right hemiparesis and right lower facial muscle weakness, but eye closure and forehead elevation were normal (a right peripheral visual field defect was present).
What is going on? |
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Definition
Left motor tract issue.
Muscle weakness of right upper and lower extremities suggests involvement of motor pathways arising from left motor cortex.
Speech difficulties could arise from Broca's aphasia in left inferior frontal gyrus and issues with site could stem from a number of issues. Also, vocalization issues could have to do with nucleus ambiguus (sounds more like forming words though than hoarsness)
Hemiparesis and right lower facial muscle weakness confirms corticospinal tract involvement and suggests involvement of trigeminal motor nuclei.
Eye closure and forehead elevation rule out opthalmic division of V |
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Term
| A 69 year old diabetic, hypertensive female noted onset of imbalance, with a left-veering gait. She complains of numbness on the right side and exam reveals incoordination on the left and reduced pinprick sensation on the left face and right body. |
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Definition
Left Medullary Syndrome (Wallenberg) (PICA infarction)
** would also expect nausea, dysarthria and dysphonia (nucleus ambiguus), as well as taste issues on ipsilateral tongue (nucleus solitarius)
Gait= Inferior cerebellar peduncle
Balance= Inferior Vestibular nuclei
"crossed signs"
Ipsilateral face pain= spinal nucleus of V
Contralateral body pain= spinothalamic tract |
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Term
A middle-aged man was shot in the abdomen and examination reveals weakness of left leg, loss of vibration and joint position sense over left leg, and absent pinprick sensation from right leg with a sensory level at T11.
Above this level, things were normal.
What is going on? |
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Definition
Hemisected spinal chord at T11 on left side, involving all 4 neurological tracts.
1) Left leg weakness suggests motor tract involvement from right hemisphere or left spinal chord lesion.
2) Left leg vibration and proprioception issues suggests left dorsal column and spinocerebellar involvement.
3) Pinprick suggests right spinothalamic lesion. |
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Term
| What is the differential diagnosis for a 63 year-old male with diabetes, hypertension and hypercholesterolemia, who has suddenly developed right hemiparesis? |
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Definition
Sudden onset favors Cerebrovascular diagnosis (insidious onset might have to do with neurodegeneration or drug-driven infection)
1) Metabolic disorder could cause cerebral cortex involvement at motor tract (hypoglycemia)
2) Lesion of left pre-central gyrus
3) Intracerebral hemorrhage
4) Ischemic cerebral infarction
5) Bleed into tumor
6) Arteriovenous malformation |
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Term
| How do patients with UMS (corticospinal, corticobulbar-subacute) typically present? |
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Definition
1) Hemiparesis, Paraparesis, Quadriparesis
2) Hyperactive tendon reflexes
3) Minimal atrophy
4) Increased muscle tone (spasticity)
5) Abnormal reflexes
6) Clonus |
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Term
| How do patients with LMS typically present? |
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Definition
1) Atrophy
2) Fasciculation
3) Reduced Tone
4) Reduced reflexes
5) Absence of pathological reflexes (present in UMS)
6) weakness in distribution of spinal cord segments, nerves and roots. |
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Term
| How do patients with Cerebral hemisphere issues typically present? |
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Definition
1) Disorders of memory, attention, executive function, emotional interaction and expression, dementia
2) Language
3) Hallucination
4) Neglect
5) Apraxia and Agnosia
6) Hemiparesis and hemisensory defects
7) Visual field disturbance
8) Seizure
9) Stupor or coma |
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Term
| How do patients with Basal Ganglia issues typically present? |
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Definition
1) Dyskinesias (chorea, tardive dyskinesia, hemiballismus, athetosis, dystonia)
2) Myoclonus and tics
3) Tremor
4) Parkinsonism |
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Term
| How do patients with Cerebellar issues typically present? |
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Definition
1) Gair ataxia
2) Extremity and speech incoordination
3) Nystagmus (oscillation of eyes) |
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Term
| How do patients with Brainstem issues typically present? |
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Definition
1) Ipsilateral cranial nerve dysfunction with contralateral motor/sensory dysfunction (crossed findings)
2) Vertigo (vestibular)
3) Gaze palsies
4) Nystagmus
5) Stupor or coma |
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Term
| What neurological dysfunction is associated with bowel and bladder dysfunctoin? |
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Definition
| Cauda Equina nerve roots. |
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