Neurological Problem Quiz

The posterior inferior cerebellar artery (PICA) is an arterial branch of the vertebral system that supplies the brain. It is responsible for supplying blood to the posterior inferior part of the cerebellum, as well as other structures in the brainstem. The other options listed are all arterial branches, but they do not specifically supply the brain.

The most likely cause of the patient's symptoms of hearing loss, unsteadiness in balance, and facial palsy on the same side is an acoustic neuroma of the cerebellopontine angle. Acoustic neuromas are benign tumors that arise from the Schwann cells of the vestibulocochlear nerve (cranial nerve VIII) and typically present with symptoms related to compression of adjacent structures. In this case, the tumor is likely compressing the vestibulocochlear nerve, leading to hearing loss, as well as affecting the facial nerve, resulting in facial palsy. The location of the tumor in the cerebellopontine angle is consistent with the patient's symptoms.

Lateral medullary syndrome (Wallenberg) is a disease in which the patient has a constellation of neurologic symptoms due to injury to the lateral part of the medulla in the brain, resulting in tissue ischemia and necrosis. This syndrome is characterized by sensory deficits affecting the trunk (torso) and extremities on the opposite side of the infarction and sensory deficits affecting the face and cranial nerves on the same side with the infarct. Specifically, there is a loss of pain and temperature sensation on the contralateral (opposite) side of the body and ipsilateral (same) side of the face. Clinical symptoms include swallowing difficulty, or dysphagia,[1] slurred speech, ataxia, facial pain, vertigo, nystagmus, Horner syndrome, diplopia, and possibly palatal myoclonus. Affected persons have difficulty in swallowing (dysphagia) resulting from involvement of the nucleus ambiguus, as well as slurred speech (dysarthria) and disordered vocal quality (dysphonia) . Damage to the spinal trigeminal nucleus causes absence of pain on the ipsilateral side of the face, as well as an absent corneal reflex. The spinothalamic tract is damaged, resulting in loss of pain and temperature sensation to the opposite side of the body. The damage to the cerebellum or the inferior cerebellar peduncle can cause ataxia. Damage to the hypothalamospinal fibers disrupts sympathetic nervous system relay and gives symptoms analogous to Horner syndrome.

The pacinian corpuscles are responsible for detecting vibrations and deep pressure in the skin. The VPL nucleus of the thalamus receives sensory input from the body, including proprioceptive and tactile information. Since the activation of pacinian corpuscles in the left hand is a tactile sensation, the VPL nucleus on the right side of the thalamus would be primarily responsible for processing this input.

The dark shaded area in the diagram represents a lesion resulting from an embolus. The paramedian branch of the basilar artery supplies blood to the lower pons. Therefore, the embolus must have occluded this artery, leading to the stroke and ultimately the patient's death.

The patient's symptoms of ataxia, marked swaying back and forth with eyes closed, and persistence of swaying even when eyes are open, suggest dysfunction of the cerebellum. The cerebellum is responsible for coordinating voluntary movements, maintaining balance, and proprioception. Damage to the cerebellum can result in impaired coordination and balance, leading to ataxia. The other structures listed, such as the dorsal columns and cerebral peduncles, are not typically associated with these specific symptoms of ataxia.

The most likely explanation for the presented symptoms is an acoustic schwannoma of the cerebellopontine angle. The patient's balance problem, hearing loss, facial muscle weakness, and absent corneal reflex on the left side are all consistent with the characteristic symptoms of an acoustic schwannoma. This type of tumor originates from the Schwann cells of the vestibulocochlear nerve (CN VIII) and can cause compression of surrounding structures, leading to a variety of neurological symptoms.

The correct answer is the anterior spinocerebellar tract. This ascending pathway carries proprioceptive information from the lower limbs to the cerebellum. It enters the cerebellum through the superior cerebellar peduncle, which is one of the three major tracts connecting the cerebellum to the brainstem. The other options listed are not associated with the superior cerebellar peduncle.

The efferent axons from the dentate nucleus terminate in the ventral lateral nucleus of the thalamus (VL) and travel through the superior cerebellar peduncle.

Lesioning or destroying the lateral nucleus of the hypothalamus would cause starvation. The lateral nucleus is responsible for stimulating appetite and regulating food intake. When the lateral nucleus is damaged, it disrupts the normal feeding behavior and leads to a decrease in appetite, resulting in starvation.

An infarct involving the hypothalamus would most likely result from occlusion of the Anterior cerebral artery. The hypothalamus is a region of the brain that plays a crucial role in regulating various bodily functions, including temperature control, hormone production, and sleep. The Anterior cerebral artery supplies blood to the frontal lobes of the brain, which includes the hypothalamus. Therefore, if this artery becomes occluded, it can lead to a lack of blood supply to the hypothalamus, resulting in an infarct or tissue death in that area.

The ventral anterior nucleus receives neuronal inputs from the basal ganglia which includes the substantia nigra and the globus pallidus. It also has inputs from the cerebellum it sends out neuronal input to the supplementary motor cortex AND to primary motor cortex.

The patient's symptoms of dizziness, vertigo, hearing loss, and tinnitus, which worsened over time, suggest a dysfunction in the inner ear. The abnormal volume of endolymph in the inner ear is a characteristic feature of Ménière's disease, a disorder that affects the balance and hearing. This condition can cause fluid buildup in the inner ear, leading to the symptoms experienced by the patient. A lesion of the medial longitudinal fasciculus, a tumor of the cerebellar vermis, damage to the spiral ganglion, a tumor affecting cranial VIII and VII at the cerebellopontine angle, or a tumor in the pons compressing the lateral lemniscus would not explain the patient's specific symptoms.

The Dorsomedial nucleus of the hypothalamus may be related to her problem. The hypothalamus plays a crucial role in regulating sleep and wakefulness, and the Dorsomedial nucleus is involved in the regulation of sleep-wake cycles. If this nucleus is not functioning properly, it could lead to excessive sleepiness and falling asleep during lectures and group activities.

Purkinje cells send inhibitory projections to the deep cerebellar nuclei, and constitute the sole output of all motor coordination in the cerebellar cortex.

The paraventricular nucleus of the hypothalamus is responsible for regulating water balance in the body. Damage to this region can lead to polyuria (excessive urination) and excessive thirst. In this case, the patient's symptoms of polyuria and excessive thirst are likely caused by the infarcted area in the diencephalon, specifically the paraventricular nucleus of the hypothalamus.

The correct answer is "Between the two heads of the right sternocleidomastoid muscle." The internal jugular vein is located between the two heads of the sternocleidomastoid muscle, making it the correct point of insertion for a central line. Placing the needle at this location ensures proper access to the vein for the procedure.

The anterior nucleus of the thalamus has both afferent and efferent limbic connections. It receives inputs from the mammillary bodies and the cingulate gyrus, which are part of the limbic system, and sends outputs to the cingulate gyrus and the hippocampus, which are also part of the limbic system. This makes the anterior nucleus an important relay station for limbic system function and contributes to emotional and memory processes.

The posterior area of the hypothalamus contains nuclei that are important for learning and memory circuits. These nuclei play a role in the consolidation and retrieval of memories.

The ansa cervicalis is a nerve that innervates the infrahyoid muscles of the neck. It runs through the omoclavicular triangle, which is an area where important structures pass through. Therefore, if there is an injury in this area, the ansa cervicalis might be in danger. The other structures listed (common carotid artery, vagus nerve, hypoglossal nerve, trunks of the brachial plexus) are not specifically mentioned as passing through the omoclavicular triangle.

The anterior scalene muscle is innervated by the brachial plexus. The brachial plexus is a network of nerves that originates from the ventral rami of spinal nerves C5-T1. It provides motor and sensory innervation to the upper limb and shoulder region. Since the anterior scalene muscle is located in the neck and helps with respiration, it makes sense that its innervation would come from the brachial plexus, which supplies the muscles of the upper limb.

The cranial base fracture in this scenario extends through the jugular foramen, which is the opening in the base of the skull where several important nerves exit. The nerves that are damaged in this case are likely the ones that innervate the muscles enclosed in the visceral layer of pretracheal fascia. Therefore, the patient will evince motor deficits specifically in these muscles.