“Lesion Impossible”
A 59 year old man presents with a sudden onset of right hemiparesis and aphasia. NIHSS: 18. A brain CT scan is obtained and you calculate the ASPECTS.
A> A score of three supports the use of IV thrombolysis
B> Three CT Scan slide cuts are required to calculate the score.
C> The maximum score is 20
D> A score of 7 or less is associated with increased dependence and death.
E> The minimum score is thereby
D> A score of 7 or less is associated with increased dependence and death.
A patient presents with sudden descending paralysis, dilated pupils, and dry mouth.
Botulism
EEG shows 3‑Hz spike‑and‑wave discharges.
Absence seizure
A patient has right homonymous hemianopia with macular sparing. Which lobe is the lesion?
Occipital Lesions
A young patient presents with unilateral weakness, aphasia, and visual aura. CT/CTA are normal. The team prepares tPA. The patient casually mentions, “My mom gets this too.” What does she have?
Hemiplegic Migraine
Hemiballismus is most commonly caused by a lesion in this nucleus.
Subthalamic nucleus
Which of the following treatment options has evidence to support its use for Guillian Barre Syndrome?
A> Oral Corticosteriods
B> IV corticosteroids
C> Plasmaphersis combined with Steriods
D> Pyridostigmine
E> IV Immunoglobin
E> IV Immunoglobin
A 47 year old woman, with confusion, fever and seizures. CSF positive for HSV encephalitis. What is the characteristic finding on EEG?
Periodic lateralized epiletiform discharges (aka lateralized periodic discharges)
A patient treated for severe hyponatremia develops dysarthria, quadriparesis, and locked‑in‑like symptoms days later. What is the diagnosis?
Osmotic demyelination syndrom
A patient has continuous unilateral headache with superimposed jabs of severe pain. Indomethacin completely resolves symptoms. What is her diagnosis?
Hemicrania Continua
Vertical gaze palsy, light‑near dissociation, and convergence‑retraction nystagmus define this syndrome caused by a lesion in the dorsal midbrain.
Parinaud syndrome
A 40 year old man presents with pain in the RLE radiating from buttock to foot. He has pain and sensory deficits along posterior thigh, leg, lateral aspect of foot. There is weakness in Plantarflexion. Patellar reflex is normal, but ankle reflex in depressed on R side. What is his like diagnosis?
S1 Radiculopathy
A comatose patient on high‑dose propofol shows alternating high‑voltage bursts and flat EEG.What is the EEG pattern?
Burst Suppression
A patient presents with agraphia, acalculia, finger agnosia, and left‑right disorientation.
Dominant inferior parietal lobule lesion
A patient has recurrent thunderclap headaches over days, triggered by exertion. CTA shows multifocal “string‑of‑beads” narrowing. What is the diagnosis?
RCVS
A patient presents with truncal ataxia and inability to sit upright without support. Where is the lesion?
Cerebellar Vermis
A 19 yr old man is arrested during an attempted robbery. While he is transported to jail, he is agitated and keeps pulling the handcuffs. The prison physician is later called to see him for numbness of his R hand because there was a concern for stroke.
On examination, he had decreased sensation over the dorsolateral aspect of R hand, with normal motor and sensation in other areas. What is the diagnosis?
A>Acute ischemic Stroke in the area of post central sulcus
B>Carpel tunnel syndrome
C> The symptoms are not consistent with any particular neurological disorder- This man is malingering
D>Superficial sensory radial neuropathy
E> C8 Radiculopathy
D>Superficial sensory radial neuropathy: Wartenburg's syndrome
What is the most accepted treatment for infantile spasms?
Adrenocorticotropic Hormone
Vigatrabin for patients with tuberoses scleorosis
A young woman develops psychiatric symptoms, dyskinesias, autonomic instability, and orofacial movements.
Anti‑NMDA receptor encephalitis
A patient has dramatic, lurching gait with wild swaying but normal strength, sensation, reflexes, and coordination when sitting or lying down. The resident orders MRI brain, spine, EMG, and neuromuscular panel- All normal. What is the gait called?
Ataxia- abasia
A patient is cortically blind but insists they can see and confabulates visual descriptions.
Anton' Syndrome
A 46 yr old man developed gait abnormality, muscle cramps, and muscle twitching overall several years, symptoms persist in sleep, otherwise in good health with no sensory or cognitive changes.
On exam- Normal Speech, language and mental status. Muscle tone and bulk were normal, but with difficulty fulling relaxing. Frequnent muscle twitches were observed. Strength was normal, and there were no sensory deficits. Reflexes normal and downing toes. Sensory and motor nerve conduction- Normal. Needle EMG showed neuromyotonic discharges. Which is the likely diagnosis?
A> Morvan Syndrome
B> Issacs Syndrome
C> Stiff person Syndrome
D> Limbic Encephalitis
E> Myotonia Congenita
B> Issacs Syndrome
A 29‑year‑old with focal to bilateral tonic‑clonic seizures has nocturnal convulsions, inconsistent medication adherence, and lives alone. EEG shows left temporal onset. MRI is normal. What single factor contributes most strongly to SUDEP risk?
Uncontrolled generalized tonic clonic seizures
A patient has abdominal pain, psychiatric symptoms, hyponatremia, and motor neuropathy after starting a new medication. Urine darkens on standing. What's the diagnosis?
Acute intermittent porphyria
In what syndrome does episodes of micropsia and macropsia occur in a migraineur?
Alice in Wonderland syndrome