I hope you find this file helpful for student preparation for the Neurology Shelf Exam.
I apologize for the intermittent beeps during the audio clips (these will be recorded again soon). Use of the accompanying transcriptions is advisable.
Sincerely,
Heather Anderson, MD
Director, Neurology Clerkship
Associate Professor of Neurology http://upload.wikimedia.org/wikipedia/commons/thumb/0/0e/Brachial_plexus_2.svg/750px-Brachial_plexus_2.svg.png

Differential for Weakness
-Plexus-
• Brachial plexus http://upload.wikimedia.org/wikipedia/commons/thumb/0/0e/Brachial_plexus_2.svg/750px-Brachial_plexus_2.svg.png

Differential for Weakness
-Plexus-
• Lumbosacral plexus http://upload.wikimedia.org/wikipedia/commo ns/thumb/7/73/Lumbar_plexus.svg/250px-
Lumbar_plexus.svg.png

Differential for Weakness
-Peripheral Nerve-
• Upper extremity
– Median nerve
– Ulnar nerve
– Radial nerve
• Lower extremity
– Peroneal nerve

Differential for Weakness
-Neuromuscular Junction-
• Myasthenia gravis
• Lambert Eaton

Differential for Weakness
-Muscle-
• Myopathy (inflammatory, endocrine and electrolyte disorders, metabolic myopathies, drugs and toxins, and infections
• Rhabdomyolysis
• Neuroleptic malignant syndrome
• Serotonin syndrome

• Review dermatomal distribution www.backpain-guide.com/Chapter_Fig_folders/Ch06_Path_Folder/4Radiculopathy

Sensory distribution of major peripheral nerves http://en.wikipedia.org/w/index.php?title=File:Gray812and814.svg&page=1 http://en.wikipedia.org/wiki/File:Gray826and831.PNG

Deficits/Findings with
Frontal Lobe Lesion
• Contralateral weakness
• Urinary incontinence w/ bilateral lesions
• Expressive aphasia
• Executive dysfunction, personality changes (prefrontal)

Deficits/Findings with
Parietal Lobe Lesion
• Contralateral sensory loss
• Inferior quadrantanopia
• Apraxia (dressing, construction, ideomotor)
• Agnosia, agraphia, acalculia, R-L disorientation (Gerstmann’s syndrome - left parietal lobe)
• Double simultaneous stimulation
(left parietal lobe)
• Neglect, apraxia, anosagnosia
(denial of deficits) (right parietal)
• Balint’s syndrome (bilateral parietal lobe)
– Inability to voluntarily control the gaze (ocular apraxia)
– Inability to integrate components of a visual scene (simultanagnosia)
– Inability to accurately reach for an object with visual guidance (optic ataxia)

Deficits/Findings with
Temporal Lobe Lesion
• Receptive aphasia (dominant laterosuperior)
– Sensory amusia, sensory aprosodia (nondominant laterosuperior)
• Superior quadrantanopia
• Kluver-Bucy (bitemporal tip) (hyperorality, hypersexuality, etc)
• Amnesia (inferomedial aspect – amygdale, hippocampus)
• Impaired recognition of facial emotional expression (nondominant lateroinferior)

Deficits/Findings with
Occipital Lobe Lesion
• Homonymous hemianopsia
• Macular sparing – watershed area, supplied by terminal branches of PCA and
MCA

Deficits/Findings with
Brainstem Lesion
• Be familiar with Wallenberg syndrome
– Lesion of lateral medulla – PICA or vertebral
– Loss of pain and temperature on ipsilateral face and contralateral limbs and trunk
– Loss of vibration, proprioception, ataxia in ipsilateral limbs
– Ipsilateral Horner's syndrome, vertigo, nystagmus, hoarseness, and dysphagia are often present

http://www.chw.edu.au/kidsrehab/brain_injury/information_sheets/_ images_/visual_field_defects.gif