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NERVOUS SYSTEM BLOCK CASE 1 A 59 years old man presents to your office complaining of severe headaches.

He tells you that his headaches are often associated with projectile vomiting. Physical exam reveals bilateral papilledema and a CT scan of the head demonstrates an irregular mass in the left cerebral hemisphere. A CT guided brain biopsy demonstrates pseudopalisading malignant cells around area of necrosis. 1. State your diagnosis based on CT findings 2. State 3 microscopic findings in this patients brain 3. Differentiate UMN lesion with LMN lesion CASE 2 A 29 years old man presents to your clinic complaining of muscle weakness. He tells you that the weakness began in his calves and has now ascended to involve his thighs, hips, torso and arms. Upon directed history, you learn that he recently recovered from flu like illness. Physical exam reveals symmetrical muscle weakness in all limbs and absent deep tendon reflexes. A lumbar puncture demonstrates an albumino-cytologic dissociation of CSF. 1. 2. 3. 4. 5. 6. CASE 3 A baby boy is born via an uncomplicated vaginal delivery. You notice a large birthmark associated with dimples and hairy tufts at the base of his back. Upon questioning his mother, you learn that she did not take any vitamins or follow a prenatal diet during her pregnancy. 1. 2. 3. 4. CASE 4 A 74 years old woman is brought to the emergency department after developing left-sided paralysis 1 hour ago. Further evaluation reveals left-sided sensory and motor paralysis, left-sided hyperreflexia, leftsided Babinski reflex and bilateral symmetric loss of vision in half of her visual fields. When you hear that she has a history of atherosclerosis, you become even more certain with your diagnosis. State 3 congenital malformations related to the neural tube and explain State further questioning you would like to ask the mother related to this condition State 2 risk factors of developing above disease State your diagnosis State your provisional diagnosis With the aid of diagram, explain the monosynaptic reflex Explain the significant of mentioning flu-like illness in this patient State the pathogenesis of disease stated above State the treatment in this patient State the complications of this disease

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1. With the aid of diagram, explain the pathophysiology of hyperreflexia in this patient 2. With the aid of diagram, explain site of lesion, artery involves and how the location of lesion will leads to this patient clinical findings 3. State the steps of formation of atherosclerosis 4. State the treatment CASE 5 A 48 years old man presents to your clinic complaining of involuntary movements of his arms and legs. He tells you that her mother had similar symptoms which eventually progress to dementia. Physical exam reveals chorea and poor concentration. When MRI of the brain demonstrates atrophy of caudate nucleus, you fear that this patient will eventually succumb to the same dementia as his mother. 1. 2. 3. 4. 5. CASE 6 A 43 years old woman presents to your office complaining of episodic loss of vision. She also reports having had severe headaches associated with nausea and vomiting over the past month. Physical exam reveals bilateral papilledema and a CT scan of the head demonstrates dilatation of the ventricular system of the brain. 1. 2. 3. 4. 5. CASE 7 A 78 years old woman brought to the emergency department by her son because of headaches and altered mental status. He tells you that the patient fells down the stairs 3 weeks ago, but that she appeared fine. Physical exam reveals bilateral papilledema and CT scan of the head reveals a crescentshaped disk on the right side of the head that crosses suture lines. 1. 2. 3. 4. Define GCS and the parameters used Differentiate subdural and epidural haematoma based on CT scan findings Explain the pathophysiology of findings in CT scan (dense or hypodense) State the anatomy of meningeal layers Explain the anatomy of CSF circulation State 3 causes of increase in cerebrospinal fluid Classify and state causes of increase in intracranial pressure What do you understand by Cushing reflex? State 1 surgical treatment in this patient Explain the anatomy of basal ganglia State your diagnosis State the causes of disease you stated above List 2 microscopic findings in this patients brain List, explain and state causes of 4 other types of hyperkinesia

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