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NERVOUS SYSTEM BLOCK

CASE 1

A 59 years old man presents to your office complaining of severe headaches. He tells you that his

headaches are often associated with projectile vomiting. Physical exam reveals bilateral papilledema

and a CT scan of the head demonstrates an irregular mass in the left cerebral hemisphere. A CT guided

brain biopsy demonstrates pseudopalisading malignant cells around area of necrosis.

1. State your diagnosis based on CT findings2. State 3 microscopic findings in this patients brain3. Differentiate UMN lesion with LMN lesion

CASE 2

A 29 years old man presents to your clinic complaining of muscle weakness. He tells you that the

weakness began in his calves and has now ascended to involve his thighs, hips, torso and arms. Upon

directed history, you learn that he recently recovered from flu like illness. Physical exam reveals

symmetrical muscle weakness in all limbs and absent deep tendon reflexes. A lumbar puncture

demonstrates an albumino-cytologic dissociation of CSF.

1. State your provisional diagnosis2. With the aid of diagram, explain the monosynaptic reflex3. Explain the significant of mentioning flu-like illness in this patient4. State the pathogenesis of disease stated above5. State the treatment in this patient6. State the complications of this disease

CASE 3

A baby boy is born via an uncomplicated vaginal delivery. You notice a large birthmark associated with

dimples and hairy tufts at the base of his back. Upon questioning his mother, you learn that she did not

take any vitamins or follow a prenatal diet during her pregnancy.

1. State 3 congenital malformations related to the neural tube and explain2. State further questioning you would like to ask the mother related to this condition3. State 2 risk factors of developing above disease4. State your diagnosis

CASE 4

A 74 years old woman is brought to the emergency department after developing left-sided paralysis 1

hour ago. Further evaluation reveals left-sided sensory and motor paralysis, left-sided hyperreflexia, left-

sided Babinski reflex and bilateral symmetric loss of vision in half of her visual fields. When you hear that

she has a history of atherosclerosis, you become even more certain with your diagnosis.

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1. With the aid of diagram, explain the pathophysiology of hyperreflexia in this patient2. With the aid of diagram, explain site of lesion, artery involves and how the location of lesion will

leads to this patient clinical findings

3. State the steps of formation of atherosclerosis4. State the treatment

CASE 5

A 48 years old man presents to your clinic complaining of involuntary movements of his arms and legs.

He tells you that her mother had similar symptoms which eventually progress to dementia. Physical

exam reveals chorea and poor concentration. When MRI of the brain demonstrates atrophy of caudate

nucleus, you fear that this patient will eventually succumb to the same dementia as his mother.

1. Explain the anatomy of basal ganglia2. State your diagnosis3. State the causes of disease you stated above4. List 2 microscopic findings in this patients brain5. List, explain and state causes of 4 other types of hyperkinesia

CASE 6

A 43 years old woman presents to your office complaining of episodic loss of vision. She also reports

having had severe headaches associated with nausea and vomiting over the past month. Physical exam

reveals bilateral papilledema and a CT scan of the head demonstrates dilatation of the ventricular

system of the brain.

1. Explain the anatomy of CSF circulation2. State 3 causes of increase in cerebrospinal fluid3. Classify and state causes of increase in intracranial pressure4. What do you understand by Cushing reflex?5. State 1 surgical treatment in this patient

CASE 7

A 78 years old woman brought to the emergency department by her son because of headaches and

altered mental status. He tells you that the patient fells down the stairs 3 weeks ago, but that she

appeared fine. Physical exam reveals bilateral papilledema and CT scan of the head reveals a crescent-

shaped disk on the right side of the head that crosses suture lines.

1. Define GCS and the parameters used2. Differentiate subdural and epidural haematoma based on CT scan findings3. Explain the pathophysiology of findings in CT scan (dense or hypodense)4. State the anatomy of meningeal layers