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Neurology 1 Flashcards

-Brain Lesions-CVA

1
Q

Visual problem in pituitary tumor compressing optic chiasm (10x)

A

bitemporal hemianopsia

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2
Q

Unsteady gait, appendicular ataxia in LE only, normal eye movement. Walks with lurching broad-based gait. Dx? (8x)

A

Cerebellar degeneration (alcoholic)

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3
Q

66y c/o frequent falls, several month h/o of anxiety, unwillingness to leave home. Exam: mild impairment of vertical gaze on smooth pursuit/saccades, mild axial rigiditiy & minimal rigidity of UE, mild slowness of finger tapping, hand opening & wrist opposition. Posture nml. Gait tentative/awkward, but w/o shuffling, ataxia, tremor. Pt slow in rising from chair. Most likely dx (8x)

A

Progressive supranuclear palsy

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4
Q

Severe occipital h/a, BL papilledema and no other abnl. Chronic acne treated wtih isotretinoin. LP elevated opening pressure with no cells, 62mg/dL glucose, 22mg/rL protein. Normal CT. Dx? (7x)

A

pseudotumor cerebri

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5
Q

79y deteriorating mental state over 3-wk period has an exaggerated startle repsonse with violent myoclonus that is elicited by turning on the room lights, speaking loudly, or touching the pt. Myoclonic jerks also seen. Dx: (5x)

A

Spongiform encephalopathy

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6
Q

Slowly progressive gait disorder, followed by impairment of mental function, and sphincteric incontinence. No papilledema or h/a reported. Likely dx? (4x)

A

Normal pressure hydrocephalus

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7
Q

65y fell several times past 6mo. MSE nl. Smooth pursuit, saccadic movements impaired. Worse w/ vertical gaze. Full ROM w/ doll head maneuver. Mild symmetric rigidity/bradykinesia, no tremor. MRI/CSF/labs unremarkable. Dx? (4x)

A

Progressive Supranuclear Palsy

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8
Q

Acute onset of pain, decr vision in R eye. Colors look faded when viewed through the R eye. On Exam, R afferent pupillary defect and swollen R optic disc. Pt spontaneously recovers over the next 6 wks. Likely to develop later. (4x)

A

Multiple sclerosis

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9
Q

28y + emotional lability & impulsivity. LFTs elevated. Close relative had similar sx and died at 30y from hepatic failure. Which blood level would dx? (3x)

A

Ceruloplasmin

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10
Q

Several days of fever + severe h/a presenting to ED b/o generalized seizure. Pt confused and somnolent. Also reported to have been irritable, c/o foul smells. T2 MRI displayed (hyperintensity of L temporal) Dx? (3x)

A

Herpes encephalitis

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11
Q

9y F has 3m h/o seemingly unprovoked bouts of laughter. Worse when not sleeping well. Pt does not feel happy during these episodes. Started menstruating 6m ago, Tanner stage 4. Dx? (2x)

A

Hypothalamic hamartoma

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12
Q

5y with 4m h/o morning h/a, vomiting, recent problems with gait, falls, diploplia (2x)

A

Medulloblastoma

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13
Q

70y + flaccid paralysis following severe water intoxication. Develops dysphagia adn dysarthria without other cranial never involvement. Sensory exam limited but grossly normal, DTRs are symmetric, cognition intact. Likely Dx (2x)

A

Central pontine myelinolysis

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14
Q

Young adult gained 70lb in last year c/o daily severe h/a sometimes associated with graying of vision. Papilledema present. CT and MRI brain shows smaller ventricles than normal. Goal of rx (2x)

A

Prevent blindness

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15
Q

Superior homonymous quandrantic defects in the visual fields result from lesions to which of the following structures? (2x)

A

Temporal optic radiations

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16
Q

Tremor with freq of ~3Hz, irregular amplitude, most evident towards the end of reaching movements. Dx? (2x)

A

cerebellar tumor

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17
Q

acute onset of fever, sore throat, diplopia & dysarthria. Exam reveals inflamed throat, L adductor nerve palsy w/ impairment of vertical pursuit, diffuse hyperreflexia w/ bilateral clonus, lower ext spasticity, & mild R hemiparesis. CT uninformative. Spinal fluid has protein 24, 10 mononuclear cells, glucose 70. Dx? (2x)

A

multiple sclerosis

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18
Q

Which is most reliable CSF finding for pt with multiple sclerosis in chronic phase of dz? (2x)

A

presence of monoclonal bands

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19
Q

Benign intracranial HTN etiology (2x)

A

hypervitaminosis A

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20
Q

Gait abnl, slow mvmt, asymmetric UE rigidity. Difficulty in voluntary vertical upward/downward gaze. Slowness/rigidity improved slightly with levodopa. Later has problems with horizontal & vertical gaze. Oculocephalic reflexes nl. Involuntary saccades. Dx? (2x)

A

Progressive supranuclear palsy

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21
Q

Pt presents with personality changes, cognitive difficulties, affective lability, and olfactory and gustatory hallucinations. The most likely medical cause of this presentation is (2x)

A

Herpes simplex virus (HSV) infection

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22
Q

What condition is a forerunniner of Multiple sclerosis? (2x)

A

transverse myelitis

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23
Q

Location of characteristic lesions seen in CT scans of pt with carbon monoxide poisoning associated comas (2x)

A

Globus pallidus

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24
Q

43yo newly w/ AIDS. Pt has inc social withdrawal and irritability over several weeks. Can’t remember phone number, unable to do chores, appears distracted. Mild R hemiparesis, L limb ataxia, bilateral visual field defects. LP normal. T2 scan shown. What is dx? (2x)

A

Progressive multifocal leukoencephalitis

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25
Q

57y new onset speech difficulty cannot name objects and sometimes cannot say “yes or no” and cannot “if ands or buts” but can follow verbal and written commands. No problems with chewing/swallowing. What is the condition? (2x)

A

Broca’s Aphasia

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26
Q

h/o dementia & myoclonus shows what pathologic changes with crystal violet changes?

A

cytosolic vacuolation of neuroglia with prion inclusions

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27
Q

What is the expected presentation with Wernicke’s encephalopathy?

A

Amnesia, confabulation, lack of insight

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28
Q

80y F lives in nursing home, believes she lives in hospital dorm and is working with maintenance staff. No distress, alert, oriented, calm, organized speech, behavior otherwise normal. Example of what memory disturbance?

A

Confabulation

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29
Q

AIDS pt with new onset h/a & cognitive decline, MRI shows multiple ring-enhancing lesions, cause?

A

Toxoplasmosis gondii

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30
Q

Neuropsychological test that examines both visual/spatial & executive functions

A

Clock drawing

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31
Q

Image of a clock, with all the numbers drawn only on the R hand side

A

Parietal lobe

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32
Q

Head injury with personality changes, impulsivity, euphoria. Site of injury?

A

Orbitofrontal cortex

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33
Q

What is the transmissible element that causes progressive decline and myoclonic jerks? Brain bx shows spongiform changes

A

Prion

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34
Q

Kluver-Bucy syndrome can be induced in animals with bilateral resection of which structures?

A

Temporal lobes –> plasticity, hyperorality, hypersexuality, hyperphagia

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35
Q

MC psych complication from TBI

A

Depression

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36
Q

Executive dysfxn comes from damage to

A

Fronto-subcortical

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37
Q

36y pt w/ double vision, vertigo, vomiting, paresis of medial rectus on lateral gaze w/ coarse nystagmus in abducting eye w/ lateral eye mvmt. Dx?

A

Multiple sclerosis

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38
Q

35y pt w/ new onset h/a, what suggests mass lesion w/ raised ICP?

A

Papilledema on eye exam

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39
Q

Aphasia 2/2 lesion in posterior third of L superior temporal gyrus. Dx?

A

Wernicke

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40
Q

5y presents w/ sudden onset slurred speech & gait difficulty. Exam shows truncal ataxia and nystagmus, mild dysarthria, extensor plantar responses. Recent h/o measles. MRI, UA, blood work unremarkable. Dx?

A

Acute cerebellitis

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41
Q

Neuro exam 59y testing slap palm of hand on knee alternating with dorsum hand rapidly. Difficulty w maneuver, clumsy, irregular. Which describes this abnl?

A

Dysdiadochokinesia

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42
Q

Abulia refers to impairment in ability to

A

Spontaneously move and speak (inability to act decisively, absence of willpower)

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43
Q

Prosopagnosia

A

Inability to recognize faces

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44
Q

56y M, normal brain scan, no prior psych hx is impulsive and disinhibited with personality changes. What would PET scan show?

A

Bilateral temporal lobes w reduced perfusion

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45
Q

Inability to recognize objects by touch

A

Astereognosis

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46
Q

Which cancer has the highest likelihood of going to the brain?

A

Lung

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47
Q

Etiology of meningitis assoc w fever, H/A, CSF pleocytosis with lymphocyte predominance, slightly elevated CSF protein, and normal CSF glucose. Dx?

A

Coxsackie Virus

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48
Q

MC solid tumor of CNS in kids

A

Neuroblastoma

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49
Q

75y pt eval for progressive gait, urine incontinence, cognitive decline. After CSF removal, improved gait & balance. CT shows?

A

Enlargement of frontal horns

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50
Q

41y chronic fatigue, cognitive impairment, reduced perceptual motor speed, poor effort maintenance, irritability (MRI: hyperintensity in frontal lobe and what looks like a finger protrusion) Dx?

A

Multiple sclerosis

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51
Q

25y w severe H/A, vomiting. Pain is dull & mostly in occipital region. Exam: b/l papilledema, otherwise WNL. LP: opening pressure 200mm H2O, no cells, 62 mg/dl glucose, 31 mg/dl protein. CT: normal. Dx?

A

Pseudotumor cerebri

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52
Q

Histology consistent with Jakob-Cretzfeldt dz

A

Cytosolic vacuolation of neurons and glia with prion inclusions

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53
Q

Dx for 68y c/o falls. PE shows upright rigid posture, stiff gait, extended knees, pivoting while turning

A

Progressive supranuclear palsy

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54
Q

Dx for 32y F w/ vertigo and Internuclear ophthalmoplegia

A

Multiple sclerosis

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55
Q

66y w frequent falls. On exam: difficulty with upward gaze & severe axial rigidity, which is less apparent in upper and lower extremities. Mild slowness of movement on finger tapping, hand opening, wrist opposition. Pt’s fingers acquire cramped pastures with effort of these tasks. The pt’s neck is extended. Gait is somewhat slow, with short steps, and the pt is slow when arising from a chair. Dx?

A

Progressive supranuclear palsy

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56
Q

70y pt develops confusion, lethargy, generalized tonic-clonic seizure. Lab reveals serum Na of 95mEq/L. This is most likely a complication of excessively rapid correction of which metabolic problem?

A

Central pontine myelinolysis

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57
Q

Hippocampal atrophy has been identified in all of the following disorders

A

MDD, Alzheimer’s Dz, PTSD (not dissociative amnesia)

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58
Q

Severe occipital H/A, b/l papilledema, vomiting. Just started birth control. LP shows elevated opening pressure no cells, 62mg/dl glucose, 31mg/dl protein, RBC 400. CT is normal. Dx?

A

Sagittal sinus thrombosis

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59
Q

Condition most likely to account for the presence of cognitive impairment in a pt with untreated HCV infxn & normal ammonia level who is HIV sero-negative

A

HCV infection of brain

60
Q

Delayed neurological deterioration followign CO-induced coma is most likely to manifest as

A

Parkinsonism

61
Q

Causative agent of progressive multifocal leukoencephalopathy (PML)

A

JC Virus

62
Q

68y pt is depressed following a hip surgery. Pt is withdrawn, looks blank, shows dysarthria, weakness, PMR, hyperreflexia, and has trouble swallowing. MRI of head will show

A

Periventricular white matter demyelination

63
Q

Adult LP with opening pressure 190, protein 110, glucose 27, leukocytes 5000. Dx?

A

Bacterial meningitis

64
Q

75y M korean war veteran, gradual development of forgetfulness, cognitive deterioration, presents with very fast/slurred speech, impaired gait. Head CT shows generalized atrophy unusual for age. LP shows 35 WBC, lymphocytosis, protein level 110mg/dl and elevated gamma globulin. Dx?

A

Neurosyphilis

65
Q

Inability to carry out motor activities on verbal command despite intact comprehension & motor function indicates

A

Apraxia

66
Q

80y pt unable to blow out match, although motor & sensory function are normal. What is this called?

A

Apraxia

67
Q

70y pt having difficulty dressing, puts both legs in one pant leg, wears underwear backwards, can’t put arms in sweater. Neuro exam unremarkable otherwise. Trouble with dressing is described as?

A

Apraxia

68
Q

MCC aseptic meningitis?

A

Enteric virus

69
Q

25y M w 7mo depression, forgetfulness, weight loss, insomnia, painful tingling in both feet & incoordination. Involuntary choeric movements of B/L UE, apathetic, monosyllabic. Labs nl. EEG: mild diffuse slowing. CT/MRI nml. During admission develops severe akinetic mutism, seizures, and dies. Brain autopsy shows

A

Diffuse amyloid plaques, spongiform neuronal degeneration, and severe astrogliosis

70
Q

52y pt with ETOH dependence presents with several days of severe h/a, nausea, low grade fever. Physical exam reveals mild disorientation, nuchal rigidity, mild spasticity in the lower extremities. Head CT unrevealing. LP 55/mm3 leukocytes (mostly lymphocytes), 45mg/dl glucose, protein 43mg/dl, presence of occasional G+ spherical cells. Most likely causative organism is

A

cryptococcus neoformans

71
Q

Describe gait in elderly male with memory impairment & gait disturbance that improves after large-volume LP

A

magnetic

72
Q

CT & MRI show ventriculomegaly out of proportion to sulcal atrophy. This is suggestive of what diagnosis?

A

normal pressure hydrocephalus

73
Q

49y pt with ETOH dependence is brought to the ED with a 1-wk history of malaise, h/a, diplopia, lethargy, confusion. On exam, the pt has a temp of 38.2C, stiff neck, medical deviation of R eye with impaired abduction & hoarseness. CSF 114 leukocytes, predominantly monocytes, a protein of 132 mg/dl, glucose of 29 mg/dl. Likely type of meningitis

A

Tuberculous

74
Q

Closed TBI, initially no LOC, then 20min later LOC. Pt recovers in 5 mins. Dx?

A

Vasovagal syncopal attack

75
Q

15y pt fell to the ground after being hit in the head while playing soccer. Pt did not lose consciousness, but was confused for the following 20min. Next day, pt reported h/a and irritability, neuro exam normal. Best recommendation to family about pt

A

Should be examined in 2 weeks before resuming play

76
Q

In ER following MVA, receives IV dextrose 5%. Experiences confusion, oculomotor paralysis, and dysarthria. Dx?

A

Wernicke’s encephalopathy

77
Q

Which of the following is invariably the first manifestation of neurosyphilis?

A

Meningitis

78
Q

14y @ summer camp, develops severe h/a & fever, drowsiness, stiffness of neck on passive forward flexion, petechial rash & skin pallor. Spinal tap reveals opening pressure 200, 84% neutrophils (7000 nucleated cells), glucose 128, protein 33. Most likely causative agent?

A

Meningococcus

79
Q

Which hormone is secreted in functional pituitary adenoma?

A

prolactin

80
Q

Primary characteristic of Wernicke encephalopathy

A

acute onset

81
Q

75y WWII veteran w gradual onset forgetfulness, intellectual deterioration, fast/slurred speech, gait-impaired, CT with normal atrophy. LP 35 WBCs (most lymph), protein 110, incr gamma globulin. Dx?

A

Neurosyphilis

82
Q

52y M presents with gait difficulties. On exam: mild dysarthria, mild finger to nose ataxia, minimal heel to shin ataxia. Romberg: negative, but very unsteady while walking & walks with broad-based lurching gait. Plantar reflexes are flexor. Imaging studies most likely to demonstrate

A

Cerebellar Vermis Atrophy

83
Q

41y pt w/o FH/o cortico-cerebellar degeneration presents with 3m h/o ataxia of gait/limbs, dysarthria, progressive nystagmus. MRI & CSF nl. (1) Antibody panel with presence of? (2) what type of tumor most likely?

A

(1) Anti-Yo
(2) Ovarian carcinoma

84
Q

MRI finding for woman w memory decline, urinary incontinence & trouble walking

A

Dilation of ventricles

85
Q

Effortful, non-fluent speech with decreased speech output; where is the lesion?

A

Anterior frontal gyrus

86
Q

50y with eye spasm in ED for SA by closed garage/running car. CT brain 2 weeks later shows:

A

Lesion in globus pallidus

87
Q

Which of the following tests is recommended by the American Academy of Neurology to establish the diagnosis of brain death?

A

Apnea test

88
Q

Essential criterion for declaration of brain death prior to organ donation requires?

A

Positive apnea test

89
Q

RF for depression in MS pt

A

Lesion volume

90
Q

R-handed pt recently underwent neurosurgery, now unable to name objects in L hand when blind-folded. He was able to name them when displayed on screen. Where was the surgery?

A

Corpus Callosum

91
Q

Bilateral paresis of medial rectus m during lateral gaze with course nystagmus in abducting eye characteristic of

A

multiple sclerosis

92
Q

82y progressive dementia, myoclonus over 3 months. EEG shows periodic sharp waves with 1 hz over both hemispheres. Dx?

A

Creutzfeldt-Jakob Dz

93
Q

Elderly man with blurry vision + eyes slow away, rapid corrections lateral gaze. Does not occur during fixation on target. What is dysfunction?

A

Vestibular labyrinth

94
Q

Lesion to which lobe causes L hemineglect?

A

R parietal lobe

95
Q

Pt w MS treated with natalizumab x2/yr presents w/ cognitive decline & weakness. MRI brain shows multiple non-enhancing plaques in subcortical white matter. Likely reactivation of what infection?

A

John Cunningham virus

96
Q

Pt who recently had a stroke seen for follow-up, appears to understand questions but often remains silent/gives 1-2 word answers with mispronunciation. Likely cause?

A

Broca’s aphasia

97
Q

Lesion to this region –> incr risk-taking behavior

A

Orbito-frontal cortex

98
Q

70y with 4m worsening cognition, urinary incontinence, difficulty walking, what is seen on MRI?

A

enlarged ventricles

99
Q

66y M with anhedeonia, blurry vision, falls, symmetrical vertical gaze palsy, subtle bradykinesia, apathy, and memory problems. Dx?

A

Progressive supranuclear palsy

100
Q

62y M w DM not making sense saying “thar szing is phrumper zu stalking”. Normal intonation but no one in the family can understand it. He verbally responds to Qs w similar utterances but fails to successfully execute any instructions. Dx? (8x)

A

Wernicke’s Aphasia

101
Q

Chronic A-fib develops aphasia and R hemiparesis at noon. ER exam notes weakness of R extremities and severe disfluent aphasia, but CT at 1:30 PM has no acute lesion. most appropriate treatment (4x)

A

TPA

102
Q

70y pt was hospitalized bc of middle cerebral artery stroke. Psychiatrist was asked to eval the pt. Pt has non-fluent aphasia. Which most likely characterized the patient’s interaction with psychiatrist? (3x)

A

The Pt was able to follow the verbal request, “Close your eyes”

103
Q

Head CT w/ lens-shaped hyperdensity (2x)

A

Epidural hematoma

104
Q

Life-threatening complication of cerebellar hemorrhage is (2x)

A

Acute hydrocephalus

105
Q

72y had embolic infarct in MCA territory. ECG shows no structural abnl. Doppler studies of neck arteries reveal <50% occlusion on both carotid arteries. EKG shows afib. Which strategy has best likelihood of reducing recurrent strokes in this patient (2x)

A

Anticoagulation with warfarin

106
Q

68y pt w HTN develops rapidly progressing R arm and L weakness, with deviation of eyes to the L. Within 30m of decific onset, pt became incr sleepy. 2 hr after onset, pt becomes unresponsive. On Exam: dense R hemiplegia, eyes deviated to the L, pupils: equal and reactive, R facial weakness to grimace elicited by noxious stimuli. Cough & gag reflexes: present. Which CT finding is most likely? (2x)

A

L putaminal hemorrhage

107
Q

Pt has multiple stroke-like sx of short duration over several days. And has new onset sx for the last 90m. CT scan shows no evidence of stroke or hemorrhage. Appropriate treatment?

A

IV thrombolytic agents

108
Q

MC psychiatric presentation following a stroke (2x)?

A

Depression

109
Q

Chiropractic adjustments are known precipitant for which acute condition?

A

Vertebral artery dissection

110
Q

MC complication of temporal arteritis is caused by occlusion of then:

A

Ophthalmic artery

111
Q

MC possible cause of posterior cerebral a infarct in 36y F with h/o migraines

A

oral contraceptives

112
Q

Abnl elevated metabolic findings assoc w incr risk of stroke in pts under 50y (2x)

A

plasma homociysteine

113
Q

L MCA stroke resulting in R hemiparesis, gait abnl (2x)

A

circumduction

114
Q

Why would brains >65y or h/o alcoholism be more susceptible to chronic subdural hematoma (2x)

A

Cortical atrophy (longer distance for bridging veins to be damaged)

115
Q

45y w R hemiparesis, CT shows L internal capsual ischemic changes extending to adjacent basal ganglia + old lacunar injury of R caudate head. LP 65 WBCs (mostly lymphocytes), 78 protein, 63 glucose + reagin abx. Tx?

A

Penicillin

116
Q

CT head large hypodensity on R frontal and parietal lobes

A

MCA stroke w/ residual L sided weakness

117
Q

contralateral leg weakness w/ personality changes is an injury where?

A

Anterior cerebral

118
Q

61y w L frontal lobe damage 2/2 cerebrovascular accident may be predisposed to which psychiatric syndrome?

A

MDD

119
Q

72y w lacunar infarct in middle cerebral artery territory. Echo is normal. Doppler studies of neck arteries reveal <50% occlusion on both carotid arteries. EKG normal. Best strategies to reduce recurrent stroke:

A

anti-plt therapy w aspirin & dipyridamole

120
Q

50y w VH of children playing. VH fully formed, colorful, vivid with no sound. Pt not scared or disturbed but amused. On exam, normal language, memory, cranial nerves, no weakness or involuntary movement, no sensory deficits. DTR symmetric. CSF/UDS nl. Dx?

A

Posterior cerebral artery ischemia

121
Q

Thrombosis of which artery results in acute h/a, inability to read, inability to write fluently, although verbal fluency intact?

A

L posterior cerebral

122
Q

What is the MC manifestation of acute neurosyphilis?

A

stroke

123
Q

65y pt wakes up with R-sided hemiparesis & motor aphasia. Pt in ED & eval within 1 hr. remaining neuro exam nl. Head CT w/o contrast nl. Next step in mgmt?

A

aspirin

124
Q

Acute onset of dense sensorimotor deficit in contralat face & arm, w milder involvement of lower extremity, assoc gaze deviation toward the opposite side of the deficit, likely indicates occlusion of:

A

superior division of the MCA

125
Q

CT scan w occipital & intraventricular hyper-intensities

A

Parenchymal hemorrhage

126
Q

Which med has secondary prevention against embolic stroke in pts w afib?

A

Oral warfarin

127
Q

Opposed to strokes caused by arterial embolism or thrombosis, caused by cerebral vein or venous sinus thrombosis:

A

Associated w seizures at onset

128
Q

Pt experienced ruptured aneurysm 5d ago in L MCA develops fluctuating aphasia and hemiparesis with no significant h/a. Underlying event:

A

vasospasm

129
Q

63y new onset aphasia & R hemiparesis. 2d ago had milder sx that resolved in 30m. Yesterday similar episode for 45m. Currenet sx started 1.5hr ago. CT shows no stroke or hemorrhage. Tx?

A

IV thrombolytic agents

130
Q

57y diabetic pt w HTN c/o several episodes of visual loss, “curtain falling” over his L eye, transient speech & language disturbance, and mild R heimparesis that lasted 2hr. Suggests presence of what?

A

extracranial L internal carotid stenosis

131
Q

Head injury, LOC -> lucid interval x hours -> rapid progressing coma. Hemorrhage?

A

Epidural

132
Q

Poststroke depression in 80y pt (R handed) is assoc w cognitive impairments that

A

Correlate with L hemispheric involvement

133
Q

66y M in ED w/ sudden occipital HA, dizziness, vertigo, n/v, unable to stand, mild lethargy, slurred speech. Exam: small reactive pupils. Gaze deviated to R, nystagmus, w/ occasional ocular bobbing, R facial weakness, decr R corneal reflex, truncal ataxia, b/l hyperreflexia, b/l babinski. Dx?

A

Cerebellar hemorrhage

134
Q

50y in ED for acute onset of neck pain radiating down L arm, progressive gait difficulty, urinary incontinence. Immediately administer which test?

A

MRI scan of cervical spine to exclude dx of spinal cord compression

135
Q

In managing acute ischemic stroke, administer this w/n 48h of onset of stroke for beneficial effect in reducing risk of recurrent stroke, disability, death

A

Aspirin

136
Q

70y w/ attacks of “whirling sensations” w n/v, diplopia, dysarthria, tingling of lips. occurs several times daily for 1 min, severe that pt collapses adn is immobilized when sx start. No residual s/s, no tinnitus, hearing impairment, ALOC or assoc w any particular activity. Dx?

A

Vertebrobasilar insufficiency

137
Q

Vascular lesion most characteristic of sudden severe h/a, vomiting, collapse, relative preservation of consciousness, few or no lateralizing neuro signs, neck stiffness

A

subarachnoid hemorrhage

138
Q

Head CT demonstrates which dx (grainy picture with diffuse speckling in posterior region, unilateral)?

A

subarachnoid hemorrhage

139
Q

mental status changes after CABG, fluent speech & excellent comprehension, inability to name fingers & body parts, R and L orientation errors inability to write down thoughts and calculation, but with good reading comprehension

A

an embolic stroke affecting L angular gyrus

140
Q

70y F sudden onset paralysis R foot & leg. R arm and hand slightly affected. No aphasia or visual field deficit. Over weeks found with loss of bladder control, abulia, lack of spontaneity. Which vascular area?

A

anterior cerebral artery (L)

141
Q

Pts in locked-in state following basilar artery occlusion typically retain what movement?

A

eyelids and vertical gaze

142
Q

83y w mild HTN comes in w new onset h/a and L hemiparesis. MRI shows R parietal lobe hemorrhage, small occipital hemorrhage and evidence of previous hemorrhage in R temporal & L parietal regions. What is likely etiology of findings?

A

amyloid angiopathy

143
Q

39y h/o multiple miscarriages develops acute L-sided hemiparesis. Work-up reveals elevated anticardiolipin titers and no other RF for stroke. Appropriate intervention at this point is?

A

plasmapheresis

144
Q

In which arterial area would a stroke resolve in inability to read but preserved ability to write?

A

posterior cerebral

145
Q

71y w Parkinson’s for 3yrs p/w difficulties getting up, is unmotivated, no interest in social events, “slowness” in thinking; motor sx well controlled on Sinemet, sx stable throughout day and no sadness, worthlessness, or SI. Cognitive eval shows slow processing. What is most likely explanation?

A

Apathy

146
Q

62y w/ bilateral posterior cerebral artery strokes reports trouble seeing b/c “lights dim” or “glasses not on”. What describes visual problem?

A

Anosognosia

147
Q

Pt suddenly becomes mute, quadriplegic, bedridden, dependent on caregivers, yet appears to be alert and able to communicate with eye movements. Most helpful test in confirming dx?

A

MRI brain with contrast

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