Neurology Clinical Cases Quiz
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Questions and Answers

What is the patient's primary complaint in the second case?

  • Weakness in the right extremities
  • Unexplained seizures
  • Facial asymmetry (correct)
  • Left-sided headache
  • What is the patient's age in the first case?

  • 60
  • 59 (correct)
  • 74
  • 73
  • What is the typical location of brain slices during dissection?

  • Sagittal (correct)
  • Coronal
  • Axial
  • Transverse
  • What is the primary role of the odd number teams in this activity?

    <p>Drawing lesions on brain slices (A)</p> Signup and view all the answers

    What does 'R-handed' indicate in the patient descriptions?

    <p>Right-handed (D)</p> Signup and view all the answers

    What is the likely diagnosis for the patient in the first case based on their symptoms?

    <p>Epilepsy (B)</p> Signup and view all the answers

    What is the clinical term used to describe the patient's experience of 'blank stares' and 'upward rolling of the eyeball'?

    <p>Aura (A)</p> Signup and view all the answers

    What does 'MMT 5/5' indicate in the context of the patient's physical exam?

    <p>Normal muscle strength (A)</p> Signup and view all the answers

    Which of the following is NOT a pertinent piece of information gathered during the patient's physical exam?

    <p>Blood pressure (C)</p> Signup and view all the answers

    What is the primary difference between the two cases presented in the information?

    <p>Presenting symptoms (A)</p> Signup and view all the answers

    What is the primary function of Vitamin D in relation to the nervous system?

    <p>All of the above. (D)</p> Signup and view all the answers

    Which of the following statements accurately describes the pathogenesis of ADEM?

    <p>ADEM is an autoimmune disorder triggered by a preceding infection or immunization. (B)</p> Signup and view all the answers

    What is the most common age group affected by ADEM?

    <p>Children and young adults. (C)</p> Signup and view all the answers

    Which of the following is a characteristic feature of ADEM's histopathology?

    <p>Perivenous demyelination with an accumulation of inflammatory cells. (B)</p> Signup and view all the answers

    What is the relationship between Vitamin D deficiency and ADEM?

    <p>Vitamin D deficiency is a known risk factor for developing ADEM. (C)</p> Signup and view all the answers

    How does Vitamin D potentially contribute to the management of ADEM?

    <p>By suppressing the inflammatory response that damages the myelin sheath. (C)</p> Signup and view all the answers

    Based on the case information provided, what is the most likely diagnosis for the patient, R.H.?

    <p>Acute Disseminated Encephalomyelitis. (D)</p> Signup and view all the answers

    What is the most recent clinical manifestation experienced by the patient, R.H. as indicated in the case?

    <p>Right Lower Extremity Weakness. (A)</p> Signup and view all the answers

    What symptoms can indicate the presence of a cerebral tumor?

    <p>Focal neurological deficits (B)</p> Signup and view all the answers

    How can an MRI with contrast help differentiate between a tumor and a cerebral abscess?

    <p>By revealing enhancement patterns (A)</p> Signup and view all the answers

    Which condition is less likely if a patient presents with seizure activity and no trauma history?

    <p>Chronic subdural hematoma (A)</p> Signup and view all the answers

    What is a key difference between the onset of tumefactive multiple sclerosis (TM) and strokes?

    <p>TM symptoms worsen gradually, unlike strokes which are more acute (D)</p> Signup and view all the answers

    Which of the following is NOT typically a symptom associated with strokes?

    <p>Rapid progression of symptoms (C)</p> Signup and view all the answers

    What does the phenomenon known as 'Dawson's fingers' indicate?

    <p>Demyelinating lesions in multiple sclerosis (B)</p> Signup and view all the answers

    What neurological function is vitamin D known to support?

    <p>Maintenance of neuronal health (D)</p> Signup and view all the answers

    Which type of weakness might a patient experience due to tumors affecting motor cortex?

    <p>Right lower extremity weakness (B)</p> Signup and view all the answers

    What is the nature of the patient's onset of symptoms?

    <p>Acute and rapidly progressive within days (A)</p> Signup and view all the answers

    Which of the following symptoms was NOT noted in the patient's examination?

    <p>Fever (A)</p> Signup and view all the answers

    What is suggested about the nature of the patient's condition?

    <p>The clinical severity can fluctuate within 3 months (A)</p> Signup and view all the answers

    Which of the following is true regarding the typical presentation of ADEM compared to the patient's case?

    <p>ADEM typically occurs only once and not recurrently (B)</p> Signup and view all the answers

    What is the significance of the last normal sensory on T6 in the context of the patient's symptoms?

    <p>Marks the transition between normal and impaired sensory function (D)</p> Signup and view all the answers

    What is the patient's chief complaint?

    <p>Decrease in sensorium (B)</p> Signup and view all the answers

    Which of the following is a relevant finding in the patient's physical examination?

    <p>Decorticate posturing (D)</p> Signup and view all the answers

    The corticospinal tract is responsible for which of the following?

    <p>Motor control of the limbs (C)</p> Signup and view all the answers

    What is the function of the medial lemniscus pathway?

    <p>Transmitting sensory information from the limbs (A)</p> Signup and view all the answers

    What is the significance of tracing the corticospinal and medial lemniscus pathways?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of the following statements about brain herniation is true?

    <p>It occurs when the brain is pushed through a small opening in the skull (C)</p> Signup and view all the answers

    Which of the following is NOT a characteristic of brain herniation?

    <p>Increased heart rate (A)</p> Signup and view all the answers

    What is a characteristic feature of Transverse Myelitis?

    <p>It typically presents with monophasic episodes. (B)</p> Signup and view all the answers

    Which structure is the largest commissural fiber in the brain?

    <p>Corpus callosum (A)</p> Signup and view all the answers

    How does the symptomatology of Transverse Myelitis compare with that of Multiple Sclerosis?

    <p>TM does not usually have a chronic relapsing course. (A)</p> Signup and view all the answers

    What is a common outcome for symptoms experienced in Transverse Myelitis?

    <p>They typically do not resolve completely. (C)</p> Signup and view all the answers

    What is the primary role of the corpus callosum?

    <p>To connect opposite cerebral hemispheres (A)</p> Signup and view all the answers

    Which brain structure is considered the most medial part of the temporal lobe?

    <p>Parahippocampal gyrus (C)</p> Signup and view all the answers

    What symptoms are indicative of a demyelinating disorder like Multiple Sclerosis?

    <p>Optic nerve involvement and relapsing episodes (A)</p> Signup and view all the answers

    Which statement about the anterior commissure is true?

    <p>It connects the temporal lobes and may be overlooked. (A)</p> Signup and view all the answers

    Flashcards

    Rostrocaudal progression

    The pattern of brain herniation from the front (rostral) to the back (caudal).

    Cerebral cortex areas

    Regions of the brain linked to functions like language and memory that can be affected in conditions like aphasia.

    Cranial neuropathies

    Disorders that affect the cranial nerves, showing specific signs and symptoms.

    Ruptured aneurysms

    Blood vessel bulges that burst, often causing severe headaches.

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    Dura mater

    The tough outer membrane surrounding the brain; crucial in migraine pathophysiology.

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    Visual field defects

    Blind spots or changes in sight caused by lesions in the visual system.

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    Corticospinal tract

    A major central nervous system pathway that controls voluntary movement.

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    Medial lemniscus pathway

    Transmission pathway for sensation of touch and proprioception from body to brain.

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    Acute Onset

    A sudden and rapid progression of symptoms over a few days.

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    Paraparesis

    Weakness or partial paralysis in the lower limbs.

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    Tetraparesis

    Weakness affecting all four limbs in the body.

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    Oculomotor Dysfunction

    Impairment affecting eye movement and coordination.

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    Monophasic Course

    A condition that occurs as a single episode without recurrence.

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    Cerebral tumors

    Abnormal growths in the brain causing symptoms like headaches and seizures.

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    Cerebral abscess

    An infection that leads to a localized collection of pus in the brain, causing similar symptoms to tumors.

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    Chronic subdural hematoma

    A collection of blood between the brain and its outermost covering, often with headache and focal deficits.

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    Ischemic stroke

    A type of stroke caused by a blockage in a blood vessel supplying blood to the brain.

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    Hemorrhagic stroke

    A type of stroke caused by bleeding into or around the brain.

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    BE FAST

    A mnemonic for recognizing stroke symptoms: Balance, Eyes, Face, Arms, Speech, Time.

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    Vitamin D in neurology

    Essential for neuronal health and brain development; linked to neurological conditions.

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    Dawson’s fingers

    A radiological finding in multiple sclerosis, indicating demyelination along the nerve pathways.

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    Vitamin D's Role

    Vitamin D regulates neurotrophic factors like NGF and detoxification in the nervous system.

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    Acute Disseminated Encephalomyelitis (ADEM)

    An acute autoimmune process characterized by rapid demyelination after infection or immunization.

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    Neurotrophic Factors

    Proteins that regulate neuron growth, survival, and differentiation, including NGF.

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    Calcium Homeostasis in Neurons

    Vitamin D helps maintain calcium levels, reducing the risk of nerve damage due to overstimulation.

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    Low Vitamin D Levels

    Linked to the onset and progression of neurodegenerative diseases like Alzheimer's disease.

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    Epidemiology of ADEM

    Primarily affects children and young adults, with an average onset age of 3.6-7 years, no sex differences.

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    Histopathology of ADEM

    Characterized by perivenous demyelination with inflammatory cells, differentiating it from MS.

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    Symptoms of ADEM

    Includes right lower extremity weakness and vision issues, with rapid progression of symptoms.

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    Cerebrum Slices

    Sagittal slices of the cerebrum for examination.

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    Patient L.A.

    59-year-old female with left-sided headache and seizures.

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    Seizure Types

    Includes blank stares, eyeball rolling, and tonic-clonic.

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    Neurological Deficits

    Loss of normal function due to brain lesions.

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    Motor Muscle Testing

    Assessment of muscle strength on both sides.

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    Patient M.L.

    74-year-old female with sudden facial drooping.

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    Facial Asymmetry

    Unequal appearance of the face due to weakness.

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    Left-Sided Weakness

    Weakness observed on the left side of the body.

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    Optic Nerve System

    Pathway from optic nerves to tracts to process vision.

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    Imaging Analysis

    Review of brain slices to identify lesions.

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    Transverse Myelitis (TM)

    A neurological disorder causing inflammation of the spinal cord, affecting myelin and leading to motor and sensory deficits.

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    Symptoms of TM

    TM commonly presents with ascending numbness, bilateral lower extremity weakness, and a defined sensory level.

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    Monophasic vs. Relapsing

    TM typically has a monophasic course with one episode, unlike multiple sclerosis (MS), which is relapsing.

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    Optic Neuritis

    Inflammation of the optic nerve, indicating systemic demyelinating disorders, absent in TM.

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    Corpus Callosum

    A large commissural fiber structure connecting the left and right cerebral hemispheres.

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    Parts of Corpus Callosum

    Major sections include the genu (anterior), body (middle), and splenium (posterior).

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    Anterior Commissure

    A small commissural structure that connects the two temporal lobes.

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    Parahippocampal Gyrus

    The most medial portion of the temporal lobe, related to memory encoding and retrieval.

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    Study Notes

    Human Body and Mind: Integration and Control Systems

    • Neuro Leap: This is a course in integration and control systems within the human body.
    • Learning Objectives: Students are expected to learn about various neurological conditions, including herniation, aphasia, seizures, and dementia, along with cranial neuropathies, ruptured aneurysms, migraines, visual field defects, corticospinal and corticobulbar tracts, and weakness patterns.
    • Station 1: Anti-Herniation
      • Case Study: A 20-year-old male from Marinduque with a history of tuberculosis and recent seizure, showing decreased consciousness.
      • Symptoms: Headaches, sudden decrease in consciousness, decorticate posturing, nonreactive pupils, slow corneal reflexes, and weak gag reflex.
      • Tasks: Arrange brain stem slices from most rostral to caudal, photograph, and identify corticospinal tract and medial lemniscus pathways.
    • Station 2: Black Box
      • Case Study: A 62-year-old female with decreased consciousness, minimal extremity movement, and moans when called.
      • Symptoms: Recent onset of decreased consciousness, moans to pain, inconsistent following commands, ptosis (drooping) of both eyes, right-sided facial palsy, sluggish right-sided corneal reflexes, and spontaneous right-sided extremity movement.
      • Tasks: Arrange brain stem slices from most rostral to caudal, photograph, and identify corticospinal tract and medial lemniscus pathways.
    • Station 3: In Pain in the Membrane
      • Case Study: A 22-year-old male patient after a vehicle accident with loss of consciousness, with epistaxis, headaches.
      • Symptoms: No eye opening to pain, no verbal output, localizes to pain, pupils 2 mm isocoric, briskly reactive to light, intact dolls, intact corneals, intact gag, and withdrawal to pain, right-sided weakness, and clonus (sustained muscle spasms) on the left side.
      • Imaging: Epidural hematoma or hemorrhage.
      • Tasks: Use imaging to identify the cause of the patient's neurological deficits and use the relevant rule of 4's.
    • Station 4: Malformation
      • Case Study: 29-year-old female with no verbal output, history of vomiting, and right-sided weakness.
      • Symptoms: No verbal output, follows commands, blood pressure at 120/80, pupils 2 mm isocoric, reactive to light, right shallow nasolabial fold, MMT findings (+), sustained clonus on the right.
      • Interpretation: Probable acute intracerebral hemorrhage (ICH) from Middle Cerebral Artery (MCA) rupture, with resulting left-sided hemiparesis and aphasia.
    • Station 5: Space Occupying lesions
      • Case Study: 59-year-old female with headaches, occasional seizures, and left-sided headache.
      • Symptoms: Headache, occasional seizures (blank stares, eye rolling, generalized tonic-clonic seizures), and right-sided weakness.
      • Interpretation: Probable space-occupying lesion (SOL) in the left hemisphere, potentially a tumor likely with increased intracranial pressure and irritation of the surrounding tissues.
    • Station 6: BE FAST
      • Specimen: Coronal sliced cerebrum
      • Tasks: Examine imaging and identify arterial territories.
    • Station 7: Demyintindihan: OGK
      • Specimen: Dissected cerebral white matter, hemisphere with corpus callosum
      • Case Study: 46-year-old female with right lower extremity weakness.
      • Symptoms: Blurring of vision (right eye) leading to blindness, new ascending numbness and weakness in bilateral lower extremities, and subsequent progressive numbness and right lower extremity weakness.
      • Interpretation: Suspected Multiple Sclerosis (MS).
    • Station 8: Decuss8
      • Specimen: Half brains (hemispheres)
      • Case Study: 74-year-old female with left-sided facial drooping.
      • Symptoms: Sudden-onset left-sided facial drooping and left-sided weakness following atrial fibrillation.
    • Station 9: Time is Brain
      • Specimen: Model brain that can be taken apart into 9 pieces.
      • Tasks: Identify specific brain structures
    • Station 10: Dis/Cord
      • Specimen: Uncut brain with spinal cord up to cauda equina.
      • Case Study: 48-year-old female with difficulty ambulating and decreased sensation.
      • Findings: Flaccid paralysis of right lower extremity, sensory deficit (pain/temperature) on right lower extremity, sensory deficit (proprioception) on left lower extremity. Possible Brown-Séquard lesion (hemisection of spinal cord).
    • Vitamin D in Neurology: Vitamin D plays a role in maintaining neuronal health, regulating brain development, and function (antioxidant properties and calcium homeostasis).

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    Neuro LEAP Past Paper PDF

    Description

    Test your knowledge on clinical neurology through a series of questions based on patient cases. This quiz covers vital aspects including diagnosis, patient symptoms, and clinical terminology related to neurology. Evaluate your understanding of key neurological principles and the assessment of various case scenarios.

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