Transcript Neurology Shelf Exam Review – Part 2

I hope you find this file helpful for student
preparation for the Neurology Shelf Exam.
I apologize for the intermittent beeps during
the audio clips (these will be recorded again
soon). Use of the accompanying
transcriptions is advisable.
Sincerely,
Heather Anderson, MD
Director, Neurology Clerkship
Associate Professor of Neurology
http://upload.wikimedia.org/wikipedia/commons/thumb/0/0e/Brachial_plexus_2.svg/750px-Brachial_plexus_2.svg.png
Differential for Weakness
-Plexus• Brachial plexus
http://upload.wikimedia.org/wikipedia/commons/thumb/0/0e/Brachial_plexus_2.svg/750px-Brachial_plexus_2.svg.png
Differential for Weakness
-Plexus• Lumbosacral plexus
http://upload.wikimedia.org/wikipedia/commo
ns/thumb/7/73/Lumbar_plexus.svg/250pxLumbar_plexus.svg.png
Differential for Weakness
-Peripheral Nerve• Upper extremity
– Median nerve
– Ulnar nerve
– Radial nerve
• Lower extremity
– Peroneal nerve
Differential for Weakness
-Neuromuscular Junction• Myasthenia gravis
• Lambert Eaton
Differential for Weakness
-Muscle• Myopathy (inflammatory, endocrine and
electrolyte disorders, metabolic
myopathies, drugs and toxins, and
infections
• Rhabdomyolysis
• Neuroleptic malignant syndrome
• Serotonin syndrome
Sensory Loss
• Review dermatomal distribution
www.backpain-guide.com/Chapter_Fig_folders/Ch06_Path_Folder/4Radiculopathy
Sensory Loss
Sensory distribution of major peripheral nerves
http://en.wikipedia.org/w/index.php?title=File:Gray812and814.svg&page=1
http://en.wikipedia.org/wiki/File:Gray826and831.PNG
Deficits/Findings with
Frontal Lobe Lesion
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•
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•
Contralateral weakness
Urinary incontinence w/ bilateral lesions
Expressive aphasia
Executive dysfunction, personality
changes (prefrontal)
Deficits/Findings with
Parietal Lobe Lesion
• Contralateral sensory loss
• Inferior quadrantanopia
• Apraxia (dressing, construction,
ideomotor)
• Agnosia, agraphia, acalculia, R-L
disorientation (Gerstmann’s
syndrome - left parietal lobe)
• Double simultaneous stimulation
(left parietal lobe)
• Neglect, apraxia, anosagnosia
(denial of deficits) (right parietal)
• Balint’s syndrome (bilateral parietal
lobe)
– Inability to voluntarily control the
gaze (ocular apraxia)
– Inability to integrate components of
a visual scene (simultanagnosia)
– Inability to accurately reach for an
object with visual guidance (optic
ataxia)
Deficits/Findings with
Temporal Lobe Lesion
• Receptive aphasia (dominant laterosuperior)
– Sensory amusia, sensory aprosodia (nondominant laterosuperior)
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•
•
•
Superior quadrantanopia
Kluver-Bucy (bitemporal tip) (hyperorality, hypersexuality, etc)
Amnesia (inferomedial aspect – amygdale, hippocampus)
Impaired recognition of facial emotional expression (nondominant
lateroinferior)
Deficits/Findings with
Occipital Lobe Lesion
• Homonymous hemianopsia
• Macular sparing – watershed area,
supplied by terminal branches of PCA and
MCA
Deficits/Findings with
Brainstem Lesion
• Be familiar with Wallenberg syndrome
– Lesion of lateral medulla – PICA or vertebral
– Loss of pain and temperature on ipsilateral face
and contralateral limbs and trunk
– Loss of vibration, proprioception, ataxia in
ipsilateral limbs
– Ipsilateral Horner's syndrome, vertigo, nystagmus,
hoarseness, and dysphagia are often present
Visual Field Cuts
http://www.chw.edu.au/kidsrehab/brain_injury/information_sheets/_
images_/visual_field_defects.gif