Clinical Cases PDF

Clinical Case #1 A 35-year-old male presents in the clinic with loss sensation in the left side of his face. He has a history of a small mass between the cerebellum and the brainstem compromising the connection with the pons. The patient is worried that an enlargement of the mass could be causing hi...

Clinical Case #1 A 35-year-old male presents in the clinic with loss sensation in the left side of his face. He has a history of a small mass between the cerebellum and the brainstem compromising the connection with the pons. The patient is worried that an enlargement of the mass could be causing his loss of sensation. 1. The face problems suggest involvement of the trigeminal nerve. This important cranial nerve: a. is associated with what roman number? b. is classified as purely sensory, principally motor or mixed? 2. The small mass location is associated with what specific peduncle? Further neurologic examination reveals loss of somatic sensations in his right lower limb as well as language problems. Interestingly, the patient can speak fluently, but demonstrate impairment of comprehension. These signs and symptoms appeared after experiencing excruciating head pain yesterday. 3. The language problem in this patient was due mainly to damage of the: 4. The most likely cerebral gyrus/cortex that could account for the loss of sensation in his extremity is: 5. The above cerebral gyrus/cortex is found in which lobe? Clinical Case #2 A married couple was brought into the emergency room after a motorcycle accident. The 21-year-old male had been found lying unconscious, without a helmet, in the street. He had facial abrasions and a swelling above his right ear. He appeared dazed and complained of headache but did not speak clearly. Physical examination revealed normal blood pressure, pulse rate and respiratory rate. Neurologic examination showed no papilledema, reactive normal pupils and normal extraocular movements. The patient was kept for observation. Several hours later the patient had become stuporous, and his right pupil was dilated. His blood pressure was 150/90 mm Hg; pulse rate, 55 BPM; and respiratory rate, 12/min. Emergency surgery was undertaken. 1. Based on clinical history, as well as signs and symptoms developed after several hours, it is suspected rupture of which important cranial vessel? 2. What is the most likely diagnosis? His 20-year-old wife was brought to the hospital with fever, chills, and a depressed level of consciousness. This female patient had been found with minor injuries but in a stuporous state. Physical examination findings included a rigid neck, a body temperature of 40°C (104°F), and a pulse rate of 140/min. Lumbar puncture revealed a cloudy CSF with presence of gram-positive pneumococci. During CSF composition analysis, WBCs, glucose, and protein CSF levels were also evaluated. 3. In terms of CSF composition analysis, you will expect to find: a. An INCREASE in which CSF level(s)? b. A DECREASE in which CSF level(s)? Why? 4. For the female patient, what is the most likely diagnosis? A 79-year-old woman is admitted to the emergency room after she was found unconscious in her apartment. After she regained consciousness, a neurologic examination indicated that she suffered a stroke with paralysis of the right arm and leg as well as loss of speech. The most likely region affected by the stroke that could account for limb paralysis is: a. Prefrontal cortex b. Precentral gyrus c. Postcentral gyrus d. Superior temporal gyrus e. Parietal lobe 2.⁠ ⁠The loss of speech in this patient was due mainly to damage of the: a. Superior frontal cortex b.Inferior temporal gyrus c.Inferior frontal gyrus d.Occipital cortex e.Medial aspect of parietal cortex During routine surgery for appendicitis, a clot is released from the lung of a 75-year-old man, causing the patient to remain unconscious for a period of 1 week. Upon regaining consciousness, the patient finds that he is unable to maintain his balance and, further, displays tremors while attempting to produce a purposeful movement. In addition, the patient's movements are not smooth but jerky and lack coordination. The region affected most likely include the: a. Spinal cord b. Medulla c. Pons d. Midbrain e. Cerebellum A magnetic resonance image scan taken of a 60-year-old woman revealed the presence of a tumor on the base of the brain that was situated just anterior to the pituitary and that impinged upon the adjoining neural tissue. A likely deficit resulting from this tumor includes: a. Loss of movement of upper limbs b. Speech impairment c. Difficulties in breathing d. Changes in emotionality e. Loss of ability to experience pain A 45-year-old man complained about having recurring headaches over a period of weeks. Subsequent tests revealed the presence of a tumor along the lateral wall of the anterior horn of the lateral ventricle, which did not produce hydrocephalus. One region that would be directly affected by the tumor is the: a. Caudate nucleus b. Putamen c. Globus pallidus d. Hippocampus e. Cingulate gyrus A 50-year-old man was admitted to the emergency room after a head injury resulting from an automobile accident. The patient was diagnosed as having a subarachnoid hemorrhage. Which of the following changes are most likely in the composition of the cerebrospinal fluid of this patient? a. Decreased protein, normal glucose, and presence of a few white blood cells b. Increased protein, normal glucose, and presence of red blood cells c. Increased protein, decreased glucose, and presence of polymorphonuclear leukocytes d. Decreased protein, normal glucose, and presence of a small number of lymphocytes e. Decreased protein, decreased glucose, and presence of tumor cells An adult male suffering from chills, fever, headache, nau-sea, vomiting, and pain in the back was admitted to the emergency room and diagnosed as having meningococcal meningitis. Which of the following changes are most likely in the composition of the cerebrospinal fluid of this patient? a. Increased protein, decreased glucose, and increased polymorphonuclear white blood cells b. Increased protein, normal glucose, and excessive number of lymphocytes c. Increased protein, normal glucose, and a few white blood cells d. Increased protein, normal glucose, and presence of tumor cells and white blood cells e. Increased protein, increased glucose, and a few white blood cells A 75-year-old man was admitted to the emergency room complaining that he had trouble walking and that he could not move his arms as well. A magnetic resonance image revealed the presence of a brain tumor. Tracer dye injected into the lateral ventricle did not appear in the lumbar cerebrospinal fluid, suggesting that the patient had developed a noncommunicating hydrocephalus. Which one of the following is the most likely location of the tumor? a. Interventricular foramen b. Cerebellar cortex c. Cerebral cortex d. Lateral thalamus e. Lateral medullary reticular formation A 22-year-old man was admitted to the emergency room after a motorcycle accident. A clinical examination showed that he had elevated intracranial pressure (ICP) due to head trauma. The patient suffered from severe bradycardia. Acting on which of the following brain regions would elevated ICP most likely cause bradycardia? a. Cerebral cortex b. Basal ganglia c. Brainstem d. Thalamus e. Cerebellum The diagram below represents a cross section of the cerebral cortex of a 65-year-old woman who suffered from a stroke and was admitted to an emergency room. The neurologist who examined her marked the infarcted region in her brain as a dark shaded area in the diagram. Occlusion of which one of the following arteries may have caused an infarction in the region represented by the dark shaded area in this diagram? Cerebral cortex a. Anterior cerebral artery b. Middle cerebral artery c. Posterior cerebral artery d. Anterior choroidal artery e. Superior cerebellar artery A 70-year-old woman suffering from loss of motor control and sensation in her left leg was examined by her neurolo-gist. Subsequent angiographic procedures performed on the patient revealed that one of the arteries supplying the brain was 80% occluded. Which one of the following arteries most likely was occluded in this patient? a. Right anterior cerebral artery b. Left anterior cerebral artery c. Posterior cerebral artery d. Posterior communicating artery e. The vertebral artery