Neurology & Special Senses

Neuroanatomy, stroke syndromes, neurodegeneration, seizures and the eye and ear.

Exam weight 6–9% · 2 QBank items · 4 flashcards

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Neuroanatomy & localisation

Broca aphasia is non-fluent with intact comprehension (inferior frontal gyrus); Wernicke is fluent with impaired comprehension (superior temporal).
Internal capsule lacunar infarct gives pure motor hemiparesis; thalamic gives pure sensory.
Spinal tracts: dorsal column crosses in the medulla; spinothalamic crosses within 1–2 levels in the cord.
Cerebellar lesions cause ipsilateral deficits; hemisphere lesions cause limb ataxia, vermis lesions cause truncal ataxia.

MCA stroke: contralateral face and arm weakness with aphasia (dominant) or neglect (non-dominant).
ACA stroke: contralateral leg weakness with urinary incontinence.
PICA (lateral medullary/Wallenberg): ipsilateral facial pain loss, contralateral body pain loss, dysphagia, Horner syndrome.
Subarachnoid hemorrhage: thunderclap headache, xanthochromia on lumbar puncture, vasospasm prevented with nimodipine.

Alzheimer: amyloid plaques and neurofibrillary tau tangles, hippocampal atrophy; ApoE4 raises risk, ApoE2 protects.
Parkinson: Lewy bodies of α-synuclein with loss of substantia nigra dopaminergic neurons — TRAPS: tremor, rigidity, akinesia, postural instability, shuffling gait.
Multiple sclerosis: periventricular plaques, oligoclonal bands in CSF, internuclear ophthalmoplegia, worsening with heat (Uhthoff).
ALS: combined upper and lower motor neuron signs with no sensory loss; riluzole extends survival modestly.

Absence seizures: 3 Hz spike-and-wave, treat with ethosuximide.
Status epilepticus: benzodiazepine first, then a loading dose of levetiracetam, fosphenytoin or valproate.
Cluster headache: unilateral periorbital pain with lacrimation and rhinorrhea; abort with 100% oxygen and sumatriptan.
Idiopathic intracranial hypertension: obese young woman, papilledema, normal imaging; treat with weight loss and acetazolamide.

Open-angle glaucoma is painless with gradual peripheral loss; closed-angle is a painful red eye with a fixed mid-dilated pupil — avoid anticholinergics.
Central retinal artery occlusion: sudden painless monocular loss with a cherry-red spot.
Rinne and Weber: conductive loss lateralises to the affected ear; sensorineural lateralises to the unaffected ear.
Cranial nerve III palsy from compression affects the pupil first (parasympathetic fibres are peripheral); ischemic palsy spares the pupil.