ASSIGNMENT 2nd Year - NEUROANATOMY

While carrying out a physical examination of a patient with an intracranial tumor, the
neurologist turns to a medical student and asks, ‘which signs and symptoms would
you look for that would enable you to localize the tumor of the region of medulla
oblongata?’ how would you have answered that question?

A 68-year-old man is admitted to hospital with the sudden onset of severe dizziness
(vertigo), hiccups, and vomiting. He also complaints of a hot, painful sensation in the
skin of the right side of face. On examination, the soft palate is drawn up to the left
side when the patient was asked to say ‘ah,’ and the right vocal cord lacked mobility
as seen on laryngoscope examination. The patient also shows drooping of right
upper eyelid (ptosis), sunken right eye (enophthalmos), and a constricted right pupil
(myosis). When asked to protrude his tongue pointed to right side. Impaired pain and
temperature sensation is evident in the trunk and extremities on the left side. Using
your knowledge of anatomy, make the diagnosis.

What is weber syndrome?

What is benedict syndrome?

A 3-moth-old girl is taken to paediatrician because her mother is concerned about

the large size of head. The child is perfectly normal in every other respect.
Examination of the child shows that the diameter of the head was larger than normal
for the age; the fontanelles are larger than normal and are larger than normal and
moderately tense. The scalp is shiny, and the scalp veins are dilated. The eyes are
normal, and the mental and physical development of the child is within normal limits.
CT and MRI of head reveal gross dilation of third and lateral ventricles of the brain.
What is your diagnosis? What possible treatment should be suggested to the mother
if this child?

A 40-year-old medical student is shown coronal and horizontal MRIs of the brain and
is asked to comment on his observations. The patient is a 55yr old man. The student
responds by saying that left lateral ventricle is larger than normal and that there is an
area of low signal intensity close to the left interventricular foramen suggesting the
presence of a brain tumor. On looking at a standard lateral radiograph of the skull
and the brain, he notes a small area of calcification ‘situated in the region of posterior
part of the left ventricle. Using your knowledge of neuroanatomy, describe the
location of lateral ventricle in the brain.
 ASSIGNMENT 2nd Year - NEUROANATOMY

a- What are the different parts of the lateral ventricle?

b-Where is the cerebrospinal fluid in the lateral ventricle produced and what does
it normally drain into?
c-What is responsible for the calcification seen in the left lateral ventricle in this
patient?

A 61-year-old man suddenly develops uncoordinated movements of the trunk and

right arm. The right upper limb will suddenly, vigorously, and aimlessly by thrown
about, knocking over anything in its path. The patient is recovering from a right-
sided hemiplegia, secondary to a cerebral haemorrhage.
a- What is the name given to this clinical sign?
b- Does this condition involve the basal nuclei?

During a ward round, a third year student was asked to explain the phenomena of
nystagmus.How would you have answered this question?Why do patients with
cerebellar disease exhibit nystagmus?

What is the essential difference b/w the symptoms and signs of acute and chronic
lesions of the cerebellum? Explain the differences.

A 37-year-old visited her physician because he had noticed clumsiness of his right
arm.The symptoms had started 6 months previously and were getting worse.He also
noticed that his right hand had a tremor when he attempted fine movements.When
he walked,he noticed now and again he tend ed to reel over to the right,”as if he had
too much alcohol or drink.”On physical examination,the face was slightly tilted to the
left and right shoulder was held lower than the left.Passive movements of the arm
and legs revealed hypotonia and looseness on the right side.When he was asked to
touch his nose with his finger , his finger overshooted the target.
Explain these signs and symptoms.Is the lesion of the cerebellum likely to be in the
midline or to one side?
 ASSIGNMENT 2nd Year - NEUROANATOMY

Two physicians were tlking in the street when one turned towards the other and
said ,”Look at that man over there. Look at the way He is walking.He is not swinging
hid right arm at all; it is just hanging down by his side. I wonder if he has a cerebellar
lesion.”Does a person with a unilateral cerebellar hemisphere tumor tend to hold the
arm limply at the side when he walks?

A 4- year old boy was taken to a neurologist because his mother was concerned
about his attacks of vomiting while walking in the morning and his tendency to be
unsteady on standing. The mother also noted that the child walked with an unsteady
gait and often fell backward. On examination, the child tended to stand with the legs
well apart- that is broad based. Ghe head was larger than the normal for his age,
and the suture lines of the skull could me easily felt. A retinal exam showed severe
papilleodema in both eyes. The muscles of upper and lower limb showed some
degree of hypotonia.No nystagmus, no tendency to fall to one side when asked to
walk.
Explain thes signs and symptoms and Is this lision is likely go be midline or to one
side?