PRITE Neuroscience Questions & Answers

60 y/o right-handed M, getting lost, only writes on right half of paper. Left-sided hemi-neglect. Where is the lesion? (8x) - ANSWERSRIGHT PARIETAL LOBE 66 y/o with HTN develops vertigo, diplopia, nausea, vomiting, hiccups, L face numbness, nystagmus, hoarseness, ataxia of limbs, staggering gait, and tendency to fall to the left. Dx? (8x) - ANSWERSLATERAL MEDULLARY STROKE 78 y/o pt had an ischemic stroke that left him with a residual mild hemiplegia. Pt appeared to be unaware that there was a problem of weakness on one side of this body. When asked to raise the weak arm, the patient raised his normal arm. When the failure to raise the paralyzed arm was pointed out to pt, he admitted that the arm was slightly weak. He also neglects the side of the body when dressing and grooming. Pt did not shave one side of his face, had difficulty putting a shirt on when it was turned inside out. Area of brain likely affected by stroke? (4x) - ANSWERSRIGHT PARIETAL LOBE 26 y.o. w/HA and R-hand clumsiness for weeks. Exam shows difficulty w/rapid alternating movements of hand, overt intention tremor on finger-to-nose, and mildly dysmetric finger tamping. CNS intact and no papilledema. Where will damage show on MRI? (4x) - ANSWERSCEREBELLUM Previously pleasant mom becomes profane and irresponsible over 6 months. Most likely a pathology in: (2x) - ANSWERSFRONTAL LOBE Rapid onset of right facial weakness, left limb weakness, diplopia: (2x) - ANSWERSBRAIN STEM INFARCTION MRI scan of head reveals an infarct in distribution of left anterior cerebral artery. Pt most likely exhibits: (2x) - ANSWERSWEAKNESS OF CONTRALATERAL FOOT AND LEG Amnesia preceded by epigastric sensation/fear is associated with electrical abnormalities where? - ANSWERSTEMPORAL LOBE Pt w/ sudden onset of L hemiparesis, L homonymous hemianopsia, tendency to gaze to right, and neglect left sided stimuli are deficits most likely result of occlusion of: - ANSWERSRIGHT MIDDLE CEREBRAL ARTERY 65 y/o w/ hx of HTN, Meniere's with sudden vertigo, N/V, worse with head movement, R beating nystagmus on lateral gaze, finger to nose testing is ataxic, poor balance and dysarthria. Dx - ANSWERSCEREBELLAR INFARCT Lower facial weakness w/ relative sparing of forehead, stroke in? - ANSWERSINTERNAL CAPSULE Higher frequency & greater severity of depression associated w/ cortical & subcortical strokes: - ANSWERSLEFT ANTERIOR FRONTAL 58 y/o s/p CABG - anomia for fingers and body parts, errors involving right and left, inability to write thoughts/take notes/make calculations. Fluent speech and excellent comprehension - ANSWERSLEFT MEDIAL TEMPORAL STROKE Visual disturbances associated with occlusion of the right posterior cerebral artery? - ANSWERSLEFT HOMONYMOUS HEMIANOPSIA 65 y/o w/ HTN collapsed. In ED is stuporous, R hemiparesis + hemisensory deficit, eyes deviate to L. CT would show intraparenchymal hemorrhage in: - ANSWERSLEFT BASAL GANGLIA Atrophy of right temporal lobe on cross section associated with occlusion of: - ANSWERSMIDDLE CEREBRAL ARTERY 58 y/o M h/o HTN, cig smoking and sudden inability to speak. Face drooping on R and dragging R leg. In ER examined within 40 mins of onset: Aphasic, unable to understand or repeat verbal commands. Unintelligible sounds for speech. Alert but appears frustrated. R hemiplegia with arm and face weaker than leg. CT head: no hemorrhage. Pathology type and area: - ANSWERSTHROMBOEMBOLIC STROKE OF LEFT MCA Sudden onset vertigo/nausea, hoarseness/dysphagia, right sided face numbness, diminished gag reflex on right, decreased pinprick and temperature sensation on left: - ANSWERSRIGHT MEDULLARY INFARCTION 65 y/o diabetic pt presents to ED c/o acute L sided weakness, deviation of gaze to R, L hemiplegia and hemisensory deficit, and L homonymous hemianopsia. 12 hrs later, pt is unconscious, L pupil enlarged and unreactive. CT will show what? - ANSWERSR MCA INFARCT W/ EDEMA AND UNCAL HERNIATION Pt with acute onset vertigo, what will suggest R lateral medullary infarct? - ANSWERSRIGHT FACIAL LOSS OF TOUCH AND TEMPERATURE SENSATION 46 y/o M w/ double vision + pain R eye. Exam: ptosis R eyelid, inability to elevate or adduct R eye + R pupillary dilation. This is caused by: - ANSWERSPOST. COMMUNICATING ARTERY ANEURYSM 65 y/o pt has a stroke which causes him to fall. On exam, weakness of the right leg, with only minor weakness of the right hand, no weakness of the face, no sensory deficit. Speech is not affected, but pt seems unusually quiet and passive. The stroke most likely involves the: - ANSWERSLEFT ANTERIOR CEREBRAL ARTERY Hemisensory loss followed by pain and hyperpathia involving all modalities and reaching the midline of trunk and head is most consistent with ischemia in the distribution of which of the following arteries? - ANSWERSPOSTERIOR CEREBRAL Right-side palsy with equal involvement of the face, arm and leg combined with third nerve palsy is most likely due to occlusion of a branch of which artery? - ANSWERSPOSTERIOR CEREBRAL Bilateral lower extremity weakness, abulia, mutism, urinary incontinence are most likely to result from occlusion of which of the following arteries? - ANSWERSAnterior cerebral Pure sensory deficit extending to midline and involving face, arm, trunk, and leg caused by lacunar infarct where? - ANSWERSLATERAL THALAMUS Blocking R PCA (posterior cerebral artery) causes which visual disturbance? - ANSWERSLEFT HOMONYMOUS HEMIANOPSIA The clinical syndrome associated with occlusion of the cortical branch of the posterior cerebral artery would result in which of the following? - ANSWERSHOMONYMOUS HEMIANOPIA WITH ALEXIA WITHOUT AGRAPHIA 28 y/o cocaine user complains of LBP, numbness in both legs and feet, thighs, buttocks, abdomen, and says R leg is weak and clumsy, L leg is tired. Has urinary incontinence and difficulty walking. Decreased light touch, pinprick, and temperature. Normal vibration and proprioception. DTR is hard to elicit. Muscle tone is normal. Decreased strength in B/L LE but worse on right. Diagnosis? - ANSWERSANTERIOR SPINAL ARTERY INFARCTION Loss of ability to execute previously learned motor activities (which is not the result of demonstrable weakness, ataxia or sensory loss) is associated with lesions of? - ANSWERSLEFT PARIETAL CORTEX Normal Romberg w/ eyes open but loses balance with eyes closed. Where is the abnormality? - ANSWERSCEREBELLAR VERMIS Motor speech paradigm activation task on fMRI - hyperactivity in right temporal lobe. Damage is where? - ANSWERSCALCARINE FISSURE Aphasia w/ effortful fragmented, non-fluent, telegraphic speech, is seen in a lesion where? - ANSWERSPOSTERIOR FRONTAL LOBE A pituitary tumor that protrudes through the diaphragmatic sella is most likely to cause? - ANSWERSBITEMPORAL HEMIANOPSIA