Questions to prepare for classes and examination
• General etiology, pathogenesis, and typical forms of pathology of the nervous system.
• Disorders of locomotion: manifestations of the upper (central) and lower (peripheral) motor neuron damage.
• Disorders of the extrapyramidal system: muscle dystonia and dyskinesia.
• Hypokinetic and hyperkinetic movement disorders: types, etiology and pathogenesis.
• Disorders of sensation: general etiology and classification.
• Positive and negative abnormal sensory phenomena.
• Hypoand hypersthesia, dysesthesia: types and mechanisms of disorders.
• Levels of sensation disorders.
• Localization of sensory abnormalities.
• Types and mechanisms of ataxia.
• Disorders of trophism. Denervation syndrome.
N 140
A 59-year-old patient D., a physician, the day before his admission to hospital woke up in the morning, got up from bed and noticed that he had difficulty in keeping the upright posture, permanently tilting to the left. After he was assisted in lying down on the bed he felt severe vertigo and nausea. When he again called for help, he noticed the emergence of aphonia (a). About an hour later he noticed emergence and then aggravation of paresthesia (b) on the right side of the body. When he was eating liquid meal (he could not eat solid meals because of nausea), regurgitaion (c) occurred.
Neurological evaluation shows the following: the leftside paresis (d) of the soft palate; a horizontal nistagmus (e) on lateral gaze, especially manifested when the patient is looking to the left; the left side facial and truncal hemihypesthesia (f); muscle hypotonia (g) and hyporeflexia (h) in the left extremities; finger-to-nose and heel-to-shin tests reveal ataxia (i) and coarse tremor (j) on the left side. The patient's blood pressure is 195/106 mm Hg; the area of cardiac dullness is increased to the left by 1.5 cm; heart rate is 90 beats per minute.