Neurology Practice Questions

Q: A patient is diagnosed with a large posterior fossa tumor compressing the cerebellum. Which symptom is most likely to be present?

Ataxia. ***Ataxia*** - Compression of the **cerebellum** directly impairs its function, leading to **ataxia**, which is characterized by problems with **coordination**, **balance**, and **gait** [1]. - Tumors in the posterior fossa frequently manifest with cerebellar signs due to their proximity [1]. *Aphasia* - **Aphasia** is a language disorder resulting from damage to brain regions involved in language processing, typically in the **frontal** or **temporal lobes** (e.g., Broca's or Wernicke's areas), which are not located in the posterior fossa. - While large tumors can cause global effects, aphasia is not a primary or direct symptom of cerebellar compression. *Hemiparesis* - **Hemiparesis** (weakness on one side of the body) is typically caused by lesions affecting the **corticospinal tracts** in the motor cortex, brainstem, or spinal cord, usually above the level of the cerebellum. - Although general brainstem compression from a large posterior fossa tumor can eventually cause motor deficits, it is not the most direct or primary symptom of cerebellar involvement. *Seizures* - **Seizures** are often associated with lesions or irritations in the **cerebral cortex**, which are located in the supratentorial compartment of the brain, not primarily the posterior fossa or cerebellum [2][3]. - While any significant intracranial mass can potentially cause seizures, tumors specifically compressing the cerebellum are less likely to present with seizures as a primary symptom compared to cortical lesions [2].

Q: A 45-year-old male presents with progressive ataxia, dysarthria, and intention tremor. MRI shows demyelinating plaques in the cerebellum. What is the most likely diagnosis?

Multiple sclerosis. ### Multiple sclerosis - The combination of **progressive ataxia**, **dysarthria**, and **intention tremor** (Charcot's triad) is highly suggestive of **multiple sclerosis** (MS), especially when coupled with cerebellar involvement [1]. - **Demyelinating plaques** seen on MRI, particularly in the cerebellum, are a hallmark pathological finding in MS, indicating an inflammatory demyelinating process in the central nervous system [1]. *Amyotrophic lateral sclerosis* - **Amyotrophic lateral sclerosis** (ALS) primarily affects **motor neurons**, leading to progressive muscle weakness, atrophy, and fasciculations, with **sensory and cerebellar functions typically spared** [2]. - While patients may experience dysarthria due to bulbar involvement, the presence of prominent ataxia and intention tremor, along with documented demyelination, makes ALS an unlikely diagnosis. *Friedreich's ataxia* - **Friedreich's ataxia** is a **hereditary neurodegenerative disorder** that typically presents in childhood or adolescence with **progressive gait and limb ataxia**, dysarthria, and loss of reflexes. - Although it causes cerebellar dysfunction, it is a genetic condition typically presenting much earlier than 45 years of age, and the MRI findings would show **cerebellar atrophy**, not demyelinating plaques, which are characteristic of inflammatory conditions. *Cerebellar tumor* - A **cerebellar tumor** could account for symptoms like **ataxia** and **dysarthria** due to mass effect or direct tissue damage [2]. - However, an MRI would typically reveal a **space-occupying lesion** rather than diffuse demyelinating plaques, and intention tremor is less specific to a tumor compared to its prevalence in MS.

Q: What is the preferred initial treatment for a patient diagnosed with Parkinson's disease who is under 65 years old and has minimal symptoms?

Dopamine agonists. ***Dopamine agonists*** - For **younger patients** (under 65) with mild Parkinson's symptoms, dopamine agonists are often preferred as initial therapy. - They tend to cause fewer motor complications compared to levodopa, delaying the onset of **dyskinesias** for several years. *Levodopa* - While highly effective, **levodopa** is typically reserved for older patients or those with more advanced symptoms due to the increased risk of **motor fluctuations** and **dyskinesias** with long-term use, especially in younger individuals. - It is the most potent symptomatic treatment for Parkinson's disease, but its long-term side effects are a concern for younger patients. *MAO-B inhibitors* - **MAO-B inhibitors** are often used as monotherapy for very mild symptoms or as an adjunct therapy to reduce the "off" time in patients already on levodopa. - They provide only modest symptomatic benefit and do not typically offer the same level of symptom control as dopamine agonists or levodopa in initial treatment. *Anticholinergics* - **Anticholinergics** are primarily used to manage **tremor** in younger patients with Parkinson's disease. - They are associated with significant side effects such as cognitive impairment, dry mouth, and constipation, making them less suitable as an initial broad-spectrum treatment, especially in older patients.

Q: A 25-year-old man presents with a history of recurrent muscle cramps, myoglobinuria, and elevated serum creatine kinase levels. Which condition is most likely?

McArdle disease. ***McArdle disease*** - **McArdle disease** (glycogen storage disease type V) is characterized by a deficiency in **myophosphorylase**, leading to an inability to break down muscle glycogen for energy during exercise. - This results in **exercise-induced cramps**, **myoglobinuria**, and significant **elevations in creatine kinase** due to muscle breakdown [1]. *Duchenne muscular dystrophy* - This is an X-linked recessive disorder caused by a mutation in the **dystrophin gene**, leading to progressive muscle degeneration [1]. - While it causes elevated CK and muscle weakness, **recurrent muscle cramps and myoglobinuria upon exertion** are not its primary defining features; rather, it presents with progressive weakness, Gowers' sign, and eventually cardiomyopathy. *Becker muscular dystrophy* - **Becker muscular dystrophy** is a milder form of Duchenne, also due to mutations in the **dystrophin gene**, but with partially functional dystrophin. - Patients experience progressive muscle weakness and elevated CK, but **recurrent exercise-induced myoglobinuria and acute cramps** are less common and less severe than in McArdle disease. *Polymyositis* - **Polymyositis** is an inflammatory myopathy characterized by immune-mediated muscle damage, leading to **proximal muscle weakness**, dysphagia, and elevated CK. - While it features elevated CK, **myoglobinuria and acute exercise-induced cramps are not typical** presenting symptoms; it's generally associated with chronic progressive weakness.

Q: A patient presents with bilateral loss of vision following a stroke. Which artery is most likely affected?

Basilar artery. ***Basilar artery*** - Occlusion of the **basilar artery** can lead to bilateral cerebral infarctions, including the **occipital lobes**, which are responsible for visual processing. - This results in sudden onset **bilateral vision loss**, often accompanied by other brainstem signs like dizziness, dysphagia, or diplopia [1]. *Anterior cerebral artery* - A stroke in the **anterior cerebral artery** typically affects the frontal and parietal lobes, leading to symptoms like **contralateral leg weakness** and sensory loss, as well as behavioral changes [1]. - It does not directly supply the primary visual cortex, so isolated bilateral vision loss is not a common presentation. *Middle cerebral artery* - The **middle cerebral artery** supplies large parts of the frontal, parietal, and temporal lobes, and is the most common site of ischemic stroke [1]. - Symptoms usually include **contralateral hemiparesis**, sensory loss, aphasia (if the dominant hemisphere is affected), and hemineglect, but not primary bilateral vision loss [1]. *Posterior cerebral artery* - A stroke in a single **posterior cerebral artery** would typically cause a **contralateral homonymous hemianopsia** (loss of vision in the same half of the visual field in both eyes). - While it supplies the occipital lobe, bilateral vision loss would require occlusion of both posterior cerebral arteries, which is less common than basilar artery occlusion for this presentation.

Q: A 60-year-old man presents with a history of recurrent transient ischemic attacks (TIAs) and now has a sudden onset of right-sided weakness and aphasia. MRI shows an infarct in the territory of the left middle cerebral artery. Which intervention is most appropriate?

Endovascular thrombectomy. ***Endovascular thrombectomy*** - This intervention is appropriate for **acute ischemic stroke** with **large vessel occlusion**, especially when performed within 6-24 hours of symptom onset in select patients, as suggested by the sudden onset of severe neurological deficits and MCA territory infarct. - Given the patient's **sudden onset of significant neurological deficits** (right-sided weakness and aphasia) and an infarct in the **left middle cerebral artery territory**, it implies a large vessel occlusion, which benefits most from **endovascular thrombectomy**. *Antiplatelet therapy* - While essential for **secondary stroke prevention**, antiplatelet therapy alone is generally insufficient for the immediate treatment of an acute, severe ischemic stroke caused by a large vessel occlusion [1]. - It would be initiated after acute management, typically within 24-48 hours, to prevent further thrombotic events, but not as the primary acute reperfusion strategy. *Intravenous thrombolysis* - **Intravenous thrombolysis** (e.g., rtPA) is effective for acute ischemic stroke if administered within a **4.5-hour window from symptom onset** and if there are no contraindications [1]. - However, for large vessel occlusions, as implied by the severe symptoms and MCA infarct, its efficacy may be limited, and it is frequently used as a bridge to **endovascular thrombectomy** rather than a standalone treatment. *Anticoagulation therapy* - Anticoagulation therapy is typically used for stroke prevention in cases of **cardioembolic stroke** (e.g., atrial fibrillation) rather than for acute ischemic stroke due to large vessel occlusion [1]. - Initiating anticoagulation immediately after an acute ischemic stroke can increase the risk of **hemorrhagic transformation** of the infarct, making it generally contraindicated in the acute phase unless specific cardiac indications prompt it after careful assessment [1].

Q: A 60-year-old man presents with sudden onset weakness on the right side of his body and difficulty speaking. MRI confirms an ischemic stroke. Which part of the brain is most likely affected?

Left frontal lobe. ***Left frontal lobe*** - **Weakness on the right side of the body** (hemiparesis) indicates an issue in the **contralateral motor cortex**, which is located in the frontal lobe [2]. - **Difficulty speaking** (aphasia), particularly expressive aphasia, is often associated with damage to **Broca's area**, which is typically located in the **left frontal lobe** in most individuals [1]. *Right frontal lobe* - Damage to the **right frontal lobe** would typically cause **weakness on the left side of the body**, not the right [2]. - While it plays a role in prosody and non-verbal communication, significant **expressive aphasia** is not primarily associated with right frontal lobe lesions [1]. *Left parietal lobe* - The **left parietal lobe** is primarily involved in **sensory processing**, spatial awareness, and language comprehension (Wernicke's area) [1]. - Damage here might lead to sensory deficits or receptive aphasia, but it is not the primary site for motor weakness or expressive aphasia. *Right parietal lobe* - The **right parietal lobe** is important for **spatial awareness**, attention, and recognizing faces and objects. - Lesions in this area can cause **left-sided neglect** or visuospatial deficits, but not typically right-sided weakness or speech production difficulties.

Q: A 35-year-old male presents with episodes of sudden, severe, unilateral headache, accompanied by nasal congestion and lacrimation. What is the most likely diagnosis?

Cluster headache. Detailed Analysis: ***Cluster headache*** - This condition presents with **sudden, severe, unilateral head pain**, often accompanied by ipsilateral **autonomic symptoms** such as nasal congestion, lacrimation, and ptosis [1]. - The episodic nature and association with these specific autonomic signs are highly characteristic of a cluster headache [1]. *Migraine* - While migraines cause **unilateral, throbbing headaches**, they are typically associated with **photophobia, phonophobia**, and nausea/vomiting, which are not mentioned here [3]. - Migraines are usually longer-lasting (4-72 hours) compared to cluster headaches, which are shorter but more frequent [1]. *Tension-type headache* - These headaches are typically **bilateral, mild-to-moderate in intensity**, and described as a **tight band around the head**, without associated autonomic symptoms [2]. - They lack the severe, unilateral pain and prominent autonomic features seen in the patient. *Trigeminal neuralgia* - This condition involves brief, **stabbing, excruciating pain** lasting seconds to minutes, primarily affecting the distribution of the **trigeminal nerve**. - It is typically triggered by touch, chewing, or talking, and does not present with the autonomic symptoms like nasal congestion or lacrimation described.

Q: A 50-year-old male presents with chronic headaches and dizziness. MRI shows periventricular and subcortical T2/FLAIR hyperintensities, some of which enhance with gadolinium. What is the likely diagnosis?

Multiple sclerosis. ***Multiple sclerosis*** - The presence of both **periventricular and subcortical T2/FLAIR hyperintensities** that **enhance with gadolinium** is highly characteristic of demyelinating plaques seen in MS, indicating active inflammation [1]. - The combination of **chronic headaches** and **dizziness**, along with imaging findings of active and older lesions (due to both enhancing and non-enhancing lesions), points strongly towards multiple sclerosis, especially given the pattern of lesions and enhancement [1]. Specific regions typical for multiple sclerosis include the periventricular, juxtacortical, and infratentorial areas [1]. *Chronic small vessel ischemic disease* - This condition typically presents with **non-enhancing white matter lesions** (leukoaraiosis) and lacunar infarcts, usually in older patients with vascular risk factors. - Enhancement with gadolinium is **not typical** for chronic small vessel ischemic disease. *Primary CNS vasculitis* - This condition can cause diffuse white matter changes and enhancement, but it often presents with strokes, encephalopathy, and focal neurological deficits, and the enhancement pattern might be **more diffuse or nodular** rather than distinctly plaquiform as in MS. - While it can cause headaches, the specific pattern of periventricular and subcortical lesions with both active and inactive plaques is **less typical** than for MS. *Migraine with white matter lesions* - Migraine can be associated with **non-specific white matter hyperintensities**, especially in individuals with a history of severe migraines. - However, these lesions typically **do not enhance with gadolinium** and are usually smaller and less numerous than those seen in MS, and they do not explain the dizziness in this pattern.

Q: A 50-year-old male with chronic alcoholism presents with ataxia and nystagmus. MRI reveals degeneration in which part of the brain?

Cerebellum. ***Cerebellum*** - **Chronic alcoholism** is a significant risk factor for **cerebellar degeneration**, leading to symptoms like **ataxia** (impaired coordination) and **nystagmus** (involuntary eye movements) [1]. - The cerebellum is crucial for **motor control**, balance, and coordination, and its damage manifests clearly in these clinical signs [2]. *Basal ganglia* - Dysfunction of the **basal ganglia** is typically associated with movement disorders such as **Parkinson's disease** (tremor, bradykinesia) or **Huntington's disease** (chorea). - While basal ganglia can be affected by alcohol due to **hepatolenticular degeneration** (Wilson's disease), the primary symptoms of ataxia and nystagmus point more directly to cerebellar involvement. *Hippocampus* - The **hippocampus** is primarily involved in **memory formation** and spatial navigation. - Damage to the hippocampus, often seen in **Wernicke-Korsakoff syndrome** (also associated with alcoholism), would lead to severe memory deficits (amnesia) rather than prominent ataxia and nystagmus as the presenting neurological signs [3]. *Thalamus* - The **thalamus** acts as a **relay station** for sensory and motor signals to the cerebral cortex and plays a role in consciousness. - While damage to the thalamus can cause various neurological deficits, **ataxia** and **nystagmus** are not its primary clinical manifestations; these symptoms are much more characteristic of cerebellar pathology [1], [3].

Question 1

A patient is diagnosed with a large posterior fossa tumor compressing the cerebellum. Which symptom is most likely to be present?

Accepted Answer

Ataxia

Answer

Aphasia

Answer

Hemiparesis

Answer

Seizures

Question 2

A 45-year-old male presents with progressive ataxia, dysarthria, and intention tremor. MRI shows demyelinating plaques in the cerebellum. What is the most likely diagnosis?

Accepted Answer

Multiple sclerosis

Answer

Amyotrophic lateral sclerosis

Answer

Friedreich's ataxia

Answer

Cerebellar tumor

Question 3

What is the preferred initial treatment for a patient diagnosed with Parkinson's disease who is under 65 years old and has minimal symptoms?

Accepted Answer

Dopamine agonists

Answer

Levodopa

Answer

MAO-B inhibitors

Answer

Anticholinergics

Question 4

A 25-year-old man presents with a history of recurrent muscle cramps, myoglobinuria, and elevated serum creatine kinase levels. Which condition is most likely?

Accepted Answer

McArdle disease

Answer

Duchenne muscular dystrophy

Answer

Becker muscular dystrophy

Answer

Polymyositis

Question 5

A patient presents with bilateral loss of vision following a stroke. Which artery is most likely affected?

Accepted Answer

Basilar artery

Answer

Anterior cerebral artery

Answer

Middle cerebral artery

Answer

Posterior cerebral artery

Question 6

A 60-year-old man presents with a history of recurrent transient ischemic attacks (TIAs) and now has a sudden onset of right-sided weakness and aphasia. MRI shows an infarct in the territory of the left middle cerebral artery. Which intervention is most appropriate?

Accepted Answer

Endovascular thrombectomy

Answer

Antiplatelet therapy

Answer

Intravenous thrombolysis

Answer

Anticoagulation therapy

Question 7

A 60-year-old man presents with sudden onset weakness on the right side of his body and difficulty speaking. MRI confirms an ischemic stroke. Which part of the brain is most likely affected?

Accepted Answer

Left frontal lobe

Answer

Right frontal lobe

Answer

Left parietal lobe

Answer

Right parietal lobe

Question 8

A 35-year-old male presents with episodes of sudden, severe, unilateral headache, accompanied by nasal congestion and lacrimation. What is the most likely diagnosis?

Accepted Answer

Cluster headache

Answer

Migraine

Answer

Tension-type headache

Answer

Trigeminal neuralgia

Question 9

A 50-year-old male presents with chronic headaches and dizziness. MRI shows periventricular and subcortical T2/FLAIR hyperintensities, some of which enhance with gadolinium. What is the likely diagnosis?

Accepted Answer

Multiple sclerosis

Answer

Chronic small vessel ischemic disease

Answer

Primary CNS vasculitis

Answer

Migraine with white matter lesions

Question 10

A 50-year-old male with chronic alcoholism presents with ataxia and nystagmus. MRI reveals degeneration in which part of the brain?

Accepted Answer

Cerebellum

Answer

Basal ganglia

Answer

Hippocampus

Answer

Thalamus

Neurology — MCQs

Neurology — MCQs

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