Stroke Syndromes
A patient presents with contralateral leg weakness, urinary incontinence, and abulia following an ischemic stroke
What is an ACA infarct?
What is the maximum recommended daily dose for baclofen?
What is 80 mg?
A patient with a mild TBI reports headache, dizziness, and difficulty concentrating despite a normal CT scan. This syndrome is the most likely diagnosis
Post-concussion syndrome
This state is characterized by the complete absence of wakefulness and awareness, with eyes remaining closed.
Coma
This scale rates independence across ADLs and mobility, widely used in inpatient rehab.
What is the Functional Independence Measure (FIM)?
Patient presents with right sided facial pain/temperature loss, left sided body pain/temperature loss, right sided Horner syndrome but no motor weakness.
What is Wallenberg syndrome (lateral medullary)?
This drug, originally developed as an antiviral, is now commonly used off-label to promote arousal and functional recovery in patients with disorders of consciousness after severe TBI. What is the drug and its mechanism of action?
Amantadine; NMDA receptor antagonist
A patient becomes agitated with diaphoresis, hypertension, tachycardia, hyperthermia, and extensor posturing after severe TBI. This syndrome is the most likely diagnosis.
Paroxysmal sympathetic hyperactivity
Six months after severe TBI, a patient demonstrates reproducible command following and purposeful object use but is unable to communicate consistently. According to the disorders of consciousness framework, this diagnosis best fits.
Minimally Conscious State
8-level behavioral rating scale, developed specifically for TBI, ranges from "no response" (Level 1) to "purposeful, appropriate response" (Level 8) and is used to monitor stages of recovery.
What is the Rancho Los Amigos Scale (RLAS)?
Patient presents with inability to abduct left eye, left facial weakness, left conjugate gaze palsy with right sided weakness.
What is Raymond-Foville syndrome?
This osmotic diuretic is commonly given for elevated ICP, working by drawing free water out of brain tissue and into the vasculature
What is mannitol?
Months after TBI, a patient develops depression, fatigue, weight gain, decreased libido, and poor rehabilitation progress. These symptoms should prompt evaluation for this endocrine complication.
Hypopituitarism
According to diagnostic criteria, this finding is sufficient to establish emergence from the minimally conscious state.
Functional object use or reliable functional communication
This assessment specifically measures post-stroke motor recovery across arm, leg, balance, and sensation domains.
What is the Fugl-Meyer Assessment?
A patient has fluent but nonsensical speech, poor auditory comprehension, impaired repetition, and is unaware of the language deficit. Motor strength is normal.
Name the type of aphasia and the artery affected, along with if its superioir or inferior
What is a dominant inferior division MCA stroke causing Wernicke aphasia
Which drug has been shown to be effective in motor recovery after an ischemic stroke
Fluoxetine
A patient with TBI insists there are no deficits despite obvious cognitive and functional impairments. This lack of awareness of one's deficits is known as:
Anosognosia
The inability to reliably communicate despite preserved consciousness should prompt clinicians to consider this diagnosis before concluding a patient has a disorder of consciousness.
Locked-in syndrome
(characterized by intact consciousness with quadriplegia and anarthria due to a ventral pontine lesion)
10-item scale as a measure of basic ADL performance, where a score of 100 indicates full independence and scores ≤40 indicate severe dependence.
What is the Barthel Index (BI)?
Why is motor function preserved in Wallenberg syndrome?
corticospinal tract (pyramidal tract) runs through the medial/ventral medulla, wallenberg affects PICA which supplies lateral medulla
In the TBI population, which antiseizure drug is prefered for partial seizure and which for general seizure?
Carbamazepine for partial seizure
Valproic acid for general seizures
Months after a severe TBI, a patient develops progressive agitation, rigidity, bradykinesia, and dystonia due to injury of the basal ganglia and dopaminergic pathways. This delayed sequela is known as:
Post-traumatic parkinsonism
This neurophysiologic test is increasingly used to identify covert consciousness in patients unable to demonstrate purposeful motor output.
EEG
This spasticity assessment tool, unlike the MAS, specifically measures the velocity-dependent component of spasticity by testing at both slow and fast speeds and grading the response on a 0–5 scale, making it more consistent with the physiological definition of spasticity.
What is the Tardieu Scale (or Modified Tardieu Scale)?