Miscellaneous

Question 1

Charles Bonnet syndrome

Answer 1

• refers to symptoms of visual hallucinations that occur in patients with visual acuity loss or visual field loss.
• Patients with visual acuity loss or visual field loss from any cause, affecting any part of the visual pathway from the eye to the visual cortex, can develop visual hallucinations. Common underlying conditions include age-related macular degeneration, glaucoma, diabetic retinopathy, and cerebral infarction
• Release hallucinations can be simple, non-formed images such as lines, light flashes, or geometric shapes, or they can be complex, formed images of people, animals, or scenes. The images are usually colored and may be static, animated, or move en bloc across the visual field. The images usually do not have emotional impact or personal meaning for the patient who almost always recognizes them as unreal

Question 2

Parinaud’s syndrome
1. Causes

2. Clinical features

Answer 2

1. Caused by injury, either direct or compressive, to the dorsal midbrain

2.

1. Supranuclear paralysis of upgaze
2. Pupillary light-near dissociation
3. convergence-retraction nystagmus
4. (conjugate down gaze “setting sun sign”)

Question 3

Signs of skull base fracture

Answer 3

• Racoon eyes-periorbital ecchymoses
• “Battle sign”- post auricular ecchymosis
• CSF Rhinorrhea
• Otorrhea

Question 4

Organophosphate poisoning

1. Symptoms
2. Treatment

Answer 4

1. sweating, miosis, lethargy, AMS, N/V/D, excess salivation (all due to the muscarinic effects) (DUMBELS)
   • Defecation, urination, miosis, bronchospasms, bradycardia, emesis, lacrimation, salivation
2. Tx: Atropine and Pralidoxime; charcoal if w/in 1 hour of ingestion, Benzos if sz

Question 5

Define asomatognosia

Where is the lesion?

Answer 5

Neglect in which the patient denies ownership of a limb

Contralateral supramarginal gyrus of the parietal lobe (usually nondominant)

Question 6

A patient has a deficit in expressing the muscial intonation of speech, leaving her monotone with limited facial expressions required to express anger, sadness, joy, surprise, or inquisitiveness.

Where is the lesion?

Answer 6

Analogous region of Broca in the nondominant frontal lobe