Block 13 Stroke Epilepsy Syncope MCQ's

Based on the information provided, the occlusion of the Anterior Cerebral Artery supplying the right hemisphere would result in a deficit in motor and sensory function in the left lower limb. This is because the Anterior Cerebral Artery supplies blood to the motor and sensory areas of the opposite side of the body. Therefore, when it is occluded on the right side, it affects the left side of the body, specifically the lower limb.

Dick's seizures are best described as distributed (generalized) seizures of the absence type. This is evident from the symptoms described, such as sitting still, inattentiveness, and staring into space distractedly. These are classic symptoms of absence seizures, which are a type of generalized seizure.

Based on the given scenario, the correct diagnosis is a complex partial seizure. This is indicated by the sudden pause in speech, followed by unintelligible words and lip smacking sounds, which are characteristic symptoms of a complex partial seizure. The confusion and abrupt end to the conversation further support this diagnosis. A complex partial seizure is a type of seizure that originates in a specific area of the brain and can cause altered consciousness and abnormal behaviors or movements.

The given symptoms of the worst headache of her life, photophobia, vomiting, positive Kernig's and Brudzinski's signs, bilateral extension on plantar reflex, and blood thoroughly mixed with CSF on lumbar puncture, are consistent with a ruptured berry aneurysm. A ruptured berry aneurysm can cause a sudden and severe headache, along with other neurological symptoms such as photophobia, vomiting, and signs of meningeal irritation like positive Kernig's and Brudzinski's signs. The presence of blood in the CSF indicates bleeding, which is commonly seen with a ruptured aneurysm. The CT scan may also show signs of bleeding in the brain.

The patient's history of three spontaneous abortions suggests a hypercoagulable state, which increases the risk of thrombotic events such as stroke. The acute onset of left sided weakness, numbness, and difficulty speaking are consistent with the symptoms of a stroke. Therefore, the most likely problem in this case is a thrombotic stroke due to the patient's hypercoagulable state.

A "lucid interval" refers to a temporary period of consciousness and normal behavior following a head injury, which is then followed by a deterioration in neurological status. This is a characteristic clinical presentation of an epidural hematoma, which is a collection of blood between the skull and the outermost layer of the brain (dura mater). In an epidural hematoma, the bleeding typically occurs from a torn artery, causing rapid accumulation of blood and increased pressure on the brain. This can lead to a brief period of consciousness before the symptoms worsen.

Syringohydromyelia is most commonly associated with Chiari type II malformation. This is a condition where the cerebellum and brainstem herniate through the foramen magnum, causing obstruction of the flow of cerebrospinal fluid (CSF). The obstruction leads to the formation of a fluid-filled cavity or syrinx within the spinal cord, known as syringohydromyelia. Chiari type II malformation is often seen in infants with spina bifida, a birth defect where the spinal column fails to close properly. It is characterized by a combination of hydrocephalus, myelomeningocele, and syringohydromyelia.

Given the information provided, Joan's symptoms suggest that she may be experiencing seizures. The jerky movements and incontinence are indicative of a seizure disorder. The fact that she has had multiple episodes in a short period of time further supports this diagnosis. The best pharmacological management for seizures would involve a combination of thiamine and diazepam administered intravenously. Thiamine is a vitamin that can help prevent brain damage associated with seizures, while diazepam is a commonly used anticonvulsant medication. Administering these medications intravenously would allow for rapid absorption and effectiveness in controlling the seizures.

The correct answer is subarachnoid bleed. The axial images from the computed tomography scan of the patient's head show signs of bleeding in the subarachnoid space, which is the area between the arachnoid membrane and the pia mater. This type of bleeding can be caused by various factors such as ruptured aneurysms, head trauma, or arteriovenous malformations. It is characterized by a sudden, severe headache and can be life-threatening if not treated promptly.

Cingulate (subfalcine) herniation occurs when the cingulate gyrus, a part of the brain, is forced under the falx cerebri, which is the membrane that separates the two cerebral hemispheres. This herniation can compress the anterior cerebral artery, leading to decreased blood flow to the frontal lobe. When blood flow is compromised, it can result in infarction, or tissue death, in the frontal lobe. Therefore, infarction in the frontal lobe is the most likely complication of cingulate herniation.

Based on the given information, the child is experiencing a short episode of lip-smacking and sweating, accompanied by a "scary feeling in his belly". The fact that the mother didn't notice any interruption in eye contact suggests that the child did not lose consciousness during the episode. These symptoms are characteristic of a simple partial seizure, which is a seizure that affects only one part of the brain and does not cause loss of consciousness.

Vertebrobasilar insufficiency refers to a reduced blood flow to the posterior part of the brain, which can cause symptoms such as dizziness, lightheadedness, and even fainting. In this case, the elderly female experiences "passing out" when she gets out of bed, suggesting a positional component to her symptoms. This is consistent with vertebrobasilar insufficiency, as changes in position can further compromise blood flow to the brain. The other options, such as side effects of sleeping medication, carotid sinus syndrome, and transient ischemic attacks, do not specifically explain the positional nature of her symptoms.

The most likely cause of the shown changes is rupture of a Charcot-Bouchard aneurysm. Charcot-Bouchard aneurysms are small, microaneurysms that occur in the small penetrating arteries of the brain. They are commonly associated with chronic hypertension and can lead to hemorrhage in the brain parenchyma, resulting in the shown changes on postmortem examination. Thrombosis or embolism of the left middle cerebral artery would typically present with different findings, such as infarction in the territory supplied by that artery. Rupture of a berry aneurysm would typically present with subarachnoid hemorrhage. Rupture of the bridging veins would typically present with subdural hemorrhage.

A person who is left-dominant typically has language functions localized in the left hemisphere of the brain. The left dorsolateral prefrontal cortex is not directly involved in language processing but is responsible for executive functions such as working memory, decision-making, and cognitive control. Therefore, it is the area that is not involved in language for a left-dominant individual.

The images from the computed tomography scan of the patient's head show signs of an acute ischemic cerebrovascular accident. This is indicated by the presence of a flaccid right hemiplegia, which suggests a loss of motor function on the right side of the body. Acute ischemic cerebrovascular accidents, also known as ischemic strokes, occur when there is a blockage or clot in a blood vessel supplying the brain, leading to a lack of blood flow and oxygen to the affected area. This can result in neurological symptoms such as weakness or paralysis on one side of the body.

Simple motor seizures and complex seizures are both types of seizures that occur in the brain. Simple motor seizures typically involve brief, involuntary muscle movements, while complex seizures involve altered consciousness and may include additional symptoms such as confusion or staring spells. One key difference between the two is that simple motor seizures rarely have sustained spasm (tonic), meaning that the muscle movements are usually brief and not prolonged. On the other hand, complex seizures can sometimes result in Todd's paralysis, which is a temporary weakness or paralysis that occurs after the seizure. This weakness typically affects the same side of the body that was involved in the seizure.

The insula is responsible for processing taste sensations, while the limbic cortex is involved in emotional responses. In this case, the patient was unable to clearly identify taste sensations on the left side of her tongue, suggesting damage to the insula. However, she was still able to respond emotionally to the taste of quinine, indicating that the limbic cortex was spared. This explains the patient's presentation of being unable to describe the taste but reacting with disgust, supporting the answer choice.