study_ing
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A 47-year-old man presents to a psychiatrist with signs and symptoms of depression. His son, who brought him in, said that he has become absent-minded, and has difficulty concentrating or remembering things. During the session, the patient makes sudden jerky movements with his hands and grimaces frequently. The psychiatrist also notes that the patient has problems with coordination and balance, and observes stuttering and slightly slurred speech during the interview. The man's mother is a healthy, 75-year-old retired saleswoman; his father committed suicide at the age of 60. IF this patient is sent for imaging studies. Which of the following will most likely be found?<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
/ A. Decrease in 18F-dopa uptake
/ B. Diffuse corticaI/cerebral atrophy
/ C. Enlarged lateral ventricles
/ D. Hypodensities in the putamen
/ E. T2 hyperintensities
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| study_ing
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2. A 63-year-old man experiences the sudden onset of a right facial droop and an inability to speak, while talking to his niece. His niece, who is a physician, rushes him to the local emergency department. On arrivaI, his vital signs are within normal Iimits. On examination, he cannot speak, and he is noted to have a marked right facial droop and right arm weakness. An emergent head CT scan does not reveal any abnormalities. Which of the following would the patient most likely be able to do on further evaluation
/ A. Name objects
/ B. Raise his eyebrows symmetrically
/ C. Repeat words
/ D. Stick out his tongue without deviation
/ E. Write words
Edited by study_ing on 09/19/06 - 12:21 AM
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| sunny2
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??
1.B
2.D
not sure 
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| saadtazjam
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1.D cuz i am going with hutingtons
2.E cuz in nondominant frontal or te,poral you see Apraxia=pt cannot follow command even if it is undestood and the patient is physically cpable of doing it??????i am not sure. Plz correct me if i am wrong
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| study_ing
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sunny 2 ur explanation?
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| study_ing
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saadtazjam u go tthe dx right for 1....
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| study_ing
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CT the head showing hypodensities in the putamen (choice D) is seen in patients with Wilson disease
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| study_ing
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Huttington's in associated with _______ atrophy?
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| saadtazjam
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caudate?
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| sunny2
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cerebral atrophy of putamen /caudate nuclei/ atrophy of the caudate nucelus.
I was not even thinking of wilson diesease here ...oops
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| study_ing
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exactly, hence on CT u wud see __________
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| saadtazjam
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Got it B,thanks a lot
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| study_ing
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ooops..!!
caudate atrophy wud not give rise to diffuse atropy. B is a feature of Alzheimer's. what does the caudate impinge upon? ( anatomically)
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| saadtazjam
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lateral ventricles?????????see i am poor in neuro i guess?????????
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| study_ing
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yup C it is.
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| saadtazjam
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Good expl,cud you pz tell us CT Differential for Enlarged lateral ventricles?
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| study_ing
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hmm will get back to this when i revise radiology/neurology..[
- however elevated CSF pressure ( and its asso causes ) wud be a cause of enlarged ventricles. ( obstructive hydrocephalus and its diffeentials cud be written here !!)
- causes of cerebral atrophy wud be another long list
- age wise too, there wud be loads of differentials..in kids, malformations eg
- ventriculomegaly with preserved parnchyma cud denote normal pressure hydrocephalus too.
i guess these wud be the broad ones
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| saadtazjam
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Hey study-ing how abt 2,i answered E but may be D,i am stuck between D and E???E cuz the reason i gave before however 12CN is not involved hence may be D?
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| study_ing
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well the reason i refrained from commenting was coz they rnt the correct options. please do support any answers u have with explanantions. that way, we'll remember more.
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| sheeezooo
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good disscussion guys..
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| saadtazjam
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Leaning towards B?????
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| study_ing
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will not comment without explanation
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| saadtazjam
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Facial LMN
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| study_ing
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pretty close, expand on that
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| saadtazjam
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With weakness resulting from lesions rostral to the nucleus of the facial nerve in the pons ("supranuclear"), there is a tendency for the forehead muscles to be uninvolved.With LMN all the Upper and Lower part of the face is Involved,I meant Facial UMN then.
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