2. 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

3. 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

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

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

6. Differential for Weakness -Neuromuscular Junction- Myasthenia gravis Lambert Eaton

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

8. Sensory Loss Review dermatomal distribution www.backpain-guide.com/Chapter_Fig_folders/Ch06_Path_Folder/4Radiculopathy

9. Sensory Loss 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

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

11. 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)

12. 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)

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

14. 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

15. Visual Field Cuts http://www.chw.edu.au/kidsrehab/brain_injury/information_sheets/_ images_/visual_field_defects.gif