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A woman brought her 75 y/o husband to the family doctor, worried that he was developing dementia. She said that he didn’t seem to understand her, and gave strange answers to her questions. She said that he sometimes used made-up words. The doctor decided to perfom a language exam. He noted that the patient’s spontaneous language had fluency, prosody and grammer, but no meaning. The patient could not name object that the doctor pointed to, or answer oral or written questions. He was unable to follow commands or repeat words. His hearing and vision seemed normal for his age. His motor and somatosensory systems were intact.Damage to which structure would most likely cause this patient’s deficits? 

A 55 year old man suddenly began having continuous wild, uncontrollable flapping and circular movements of the left arm, and occasional jerky movements of the left leg. Further neurologic testing was unremarkable.  What is suggested by uncontrollable flapping of the left arm and jerky movements of the left leg?

Which of the following DOES NOT supply the area of this lesion?

A 22-year-old male is brought to the ER with knife wounds and the following symptoms: -> initial flaccid paralysis of his right arm and leg, -> deficits in proprioception and vibratory sensation on his right side below the level of C6, and -> decreased pain and temperature sensation on his left side below the level of C4. A lesion in which of the following locations best accounts for deficits in pain and temperature sensation below level of C4?

A 56 year old man presented with paralysis of muscles of facial expression on the entire left side of the face. Further examination revealed that the man had ataxia with a tendency to fall toward the left and there was also loss of pain and temperature from the left side of the face and right side of the body. Additionally, it was noted that there was decreased sweating, miosis, and ptosis on the left side of the face. This and the next 4 questions apply to this case (6-10). What is the significance of facial muscle paralysis on the entire left side of the face?

This case applies to this and the following 2 questions. A 64-year-old man presents with complaint of double vision. -> On right horizontal gaze, his left eye adducts and the right eye abducts. -> On left horizontal gaze, the left eye abducts normally but the right eye fails to adduct. Given only these specific symptoms what damaged structure(s) could be involved?

A 71 y/o male with a history of hypertension presents to the ER complaining of dizziness, nausea, vomiting, headache and difficulty sitting and standing. His wife reported that he had slurred speech and shaking of his left arm. He was ataxic on left finger-nose and heel-shin testing, but normal on the right. He had great difficulty performing the tandem gait and had a positive Rhomberg test, and stumbled to the left (a clinician asks a patient to close their eyes The essential features of the test are as follows: the subject stands with feet together, eyes open and hands by the sides, the subject closes the eyes while the examiner observes for a full minute. If the patient falls, they have a positive Rhomberg sign). His somatosensory modalities were intact. Eye exam revealed slight bilateral papilledema. This case refers to this and  the next 5 questions (11-16). Dizziness, nausea, vomiting and ataxia are tell tale:

What could be causing the papilledema? (feedback)

A 59 year old man was brought to the emergency room by his wife because he “suddenly couldn’t feel anything”. Examination revealed absence of discriminative touch, vibration sense and proprioception from his right upper and lower extremities. There was also absence of pain and temperature sensation from the right side of his face and left side of his body. A motor examination revealed weakness in turning his head toward the left and in shrugging the right shoulder. Horner’s syndrome was also present on the right. The next 3 questions concern this case. This case refers to the next 3 questions (1-4). What is suggested by the absence of discriminative touch, vibration sense and proprioception from the right upper and lower extremities?

This case applies to this and the following question. A 26-year-old male was brought by ambulance to the ER after having been in an automobile accident. During examination the patient was completely lucid-alert and oriented to person, place, and time. A CT scan showed a large, lens-shaped fluid collection along the inner surface of the left temporal and parietal bones. A fracture of the left temporal bone could also be seen. Some time later, after the CT scan was taken one of the nurses noted that the patient was some what agitated and had a decreased level of consciousness. Further examination revealed that the patient’s left pupil was fixed and dilated and that the right arm and leg were weak with increased reflexes. What does the fixed dilated pupil on the left suggest?