5.6 Pattern recognition in neurology

Question 1

pyramidal
UMN features
-pyramidal weakness
-spasticity

Answer 1

corticospinal / pyramidal tract

Question 2

EPS

Answer 2

basal ganglia

Question 3

ataxia

Answer 3

cerebellum

Question 4

truly generalised weakness should include

Answer 4

bulbar motor function

otherwise, quadri/tetraparesis

Question 5

UMN pattern weakness is—?

Answer 5

weak extensors in arm

weak flexors in leg

Question 6

causes of UMN pattern of weakness

Answer 6

stroke
SOL
spinal cord problems

Question 7

what kind of pattern will these cause?

• motor neuron disease
• spinal muscular atrophy
• lead poisoning
• polimyelitis

Answer 7

anterior horn cell - lower motor neurone lesion

Question 8

organophosphate poisoning inhibits which enzyme?

Answer 8

acetylcholinesterase

Question 9

causes of hemicord damage symptoms

• lost spinothalamic (temperature, pain)
• preserved dorsal colum (vibration, light touch, proprioception)

Answer 9

anterior spinal artery syndrome
brown sequard syndrome
syingomyelia

Question 10

cerebellar signs

Answer 10

broad unstead gait
intention tremor/ataxia
dysdiadochokinesis - clumsy fast alternating movements
nystagmus
dysarthria

Question 11

damage here causes disinhibition

-hunger, thirst, sexual functions becomes disinhibited

Answer 11

orbitofrontal cortex

Question 12

damage here causes decreased response to external stimuli

Answer 12

dorsolateral prefrontal cortex

Question 13

damage here causes abulia - lack of will or akinetic mutism

Answer 13

cingulate gyrus and dorsomedial frontal lobe

-motivation is affected

Question 14

where does auditory dysfunction localise to?

Answer 14

herschel’s gyrus of temporal lobe

Question 15

syndrome:
- dysgraphia
- left right disorientation
- finger agnosia
- acalculia

Answer 15

Gerstmann’s syndrome

-disease of the domiant angual gyrus, in the inferior parital lobe

Question 16

site of lesion for:

-inattention

Answer 16

non-dominant angular gyrus of parietal lobe

Question 17

where would deep brain stimulation work for parkinsons disease?

Answer 17

subthalamic nucleus

globus pallidus internal

Question 18

cross the blood brain barrier and act directly as D2-type receptors. These agents include pramipexole, ropinirole, and bromocriptine.

Answer 18

Dopamine agonists

Question 19

such as selegiline and rasagiline can improve symptoms in patients with mild disease (as monotherapy) as well patients already on levodopa.

Answer 19

MAO-B inhibitors

Question 20

such as trihexyphenidyl or diphenhydramine (Benadryl) aim to combat tremor, but usually cause severe side effects

Answer 20

Anticholinergics

Question 21

blocks NMDA receptors and has a mild attenuation of resting tremor and dystonia. May alleviate levodopa induced dyskinesias.

Answer 21

Amantadine

Question 22

diagnosis of MS

Answer 22

neurological assessment

MRI imaging brain- including gadolinium contrast

Question 23

primary lateral sclerosis- affects which modality

Answer 23

upper motor neurone ONLY

Question 24

what imaging identifies old lesions and lesions of non-vascular origin in ischaemic stroke?

Answer 24

MRI T1/2 and FLAIR imaging

Question 25

what imaging identifies new ischaemic lesions in stroke?

Answer 25

Diffusion weighted images -hyperintensities in stroke decreased signal on apparent diffusion coefficient of water

Question 26

What imaging for bleeds and microbleeds (stroke)?

Answer 26

T2

Question 27

What imaging for identifying brain areas at risk of ischaemia?

Answer 27

perfusion weighted images

Question 28

name the lesion No visual field defect No new higher cortical or brainstem dysfunction Pure motor hemiparesis, or pure sensory deficit of one side of the body, or sensorimotor hemiparesis or ataxic hemiparesis (dysarthric clumsy hand syndrome or ipsilateral ataxia with crural hemiparesis) At least 2 of the 3 areas (face, arm, leg) should be involved in its entity

Answer 28

lacunar syndrome

Question 29

``` name the syndrome- any 1 of: Cranial nerve palsy Unilateral or bilateral motor or sensory deficit Disorder of conjugate eye movements Cerebellar dysfunction Homonymous hemianopia Cortical blindness ```

Answer 29

posterior circulation syndrome

Question 30

name the syndrome : Hemiplegia and homonymous hemianopia contralateral to the lesion, and Either aphasia or visuospatial disturbances +/- sensory deficit contralateral to the lesion

Answer 30

total anterior circulation syndrome

Question 31

name the syndrome: One or more of unilateral motor or sensory deficit, aphasia or visuospatial neglect (with or without homonymous hemianopia) Motor or sensory deficit may be less extensive than in lacunar syndromes

Answer 31

partial anterior circulation syndrome