Find The Lesion Student View

ALA: Find the Lesion Group Project
Objectives:
Completion of this activity will fulfill the following Course Objectives:
• Objective 1: Build a comprehensive vocabulary pertaining to the anatomy, physiology and

pathophysiology of the central nervous system in order to communicate with healthcare
professionals.
• Objective 4: Demonstrate proficiency in using anatomical and physiological principles to

solve clinical problems.
• Objective 5: Interpret the results of a comprehensive neurological examination.
• Objective 6: Demonstrate and reflect upon professional and inter-professional behaviors

with learners, faculty and other members of the medical education team including
punctuality, reliability, preparation, interaction and participation in all required learning
encounters.
Directions for ALA:
• Cases are assigned based on Clinical Small Group Number.
• Clinical small groups will work together to answer the questions related to the case.
• While there is reserved class time on April 19th from 8-9:50 am to prepare, it can be
completed at any time. However, all members of the group must participate.
• Groups will present their case to the entire class. Presentations will last between 4-5
minutes, with 5 minutes after the case for questions and discussion.
• Groups 1-7 will present their case to the class on April 24th from 10:00 - 10:50 am
• Groups 8-20 will present their case to the class on April 26th from 10 - 11:50 am
• Completion of this assignment will count towards the Small group/Team work assignments
grade for the Neurosensory course. This assignment will be graded on the following:
• Active participation of all members of the group
• Class presentation, which can include slides, images, notes, or verbal presentation
• Additionally, there will be questions on the Neurosensory Final covering this material.
• There is not a “key”- rather, the information will be shared and discussed during class
presentations.
Page 1 of 21
Group 1:
A 82-year-old female with past medical history of hypertension, diabetic neuropathy and 1 PPD
smoking history presents to the emergency department with left leg weakness and a clumsy
left hand. She woke up this morning and was unable to get out of bed, and fell to the ground,
fracturing her left wrist. She was able to call an attendant at her assisted living facility for help.
On examination, the patient is alert and oriented to person and place, but not time. She has a
decreased left nasolabial fold and mild dysarthria. She has 1/5 strength in the left leg, and 4/5
strength in the left arm. Interestingly, when attending to other tasks during the examination, the
patient’s left arm acts independently, sometimes trying to pull off the blood pressure cuff or her
IV. She has 3+ reflex at the left patella, but 1+ at the ankle bilaterally. She is unable to ambulate
due to weakness. She has up-going toes on the left. She is unable to tell pinprick sensation on
the left side of her body. She has extinction on the left side with double simultaneous tactile
stimulation.
1. What are the pertinent physical exam findings?
2. Where is the intracranial lesion? Which side?
3. What is the vascular supply?
4. What clinical syndrome is describe as “her hand acting independently of the other”. What
structure is damaged to cause this?
5. What is “dysarthria”? How is this different from “aphasia”?
6. Why does this patient most likely have diminished reflexes in the Achilles bilaterally?
7. List 3 differential diagnosis, in order of most to least likely. Give supporting and refuting
evidence for these differential diagnosis.
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Page 2 of 21
Group 2:
A 71-year-old female presents to the emergency department with sudden difficulties speaking
and right sided weakness. 2 weeks prior to her admission, the patient was diagnosed with
atrial fibrillation. She was started on Coumadin. 1 hour prior to being seen in the emergency
department, while eating breakfast with her husband, she developed sudden difficulties with
speech, and dropped her fork due to weakness. An ambulance was called, and she was
brought to the ED for further evaluation.
On physical examination, the patient has irregular rate and rhythm. Neurological exam reveals
the patient is unable to state her name, and thus, orientation is difficult to assess. She is only
able to say “Yes” or “No”. She is unable to repeat, name, write, or read, and this frustrates her.
She is able to sing “Twinkle Twinkle Little Star”. She does follow commands. Her voice is
hypophonic, and she has slurred speech. She blinks to threat bilaterally. She has marked
weakness of the right lower face. She has 4/5 strength in the right arm and 5/5 strength in the
right leg. Her finger-to-nose testing is intact bilaterally. She has intact sensation in all 4
extremities.
4. Why is this patient able to sing common songs, but not state her name or repeat?
5. Why is it important that the patient follows commands and is frustrated by her deficits?
How does this information localize the lesion?
6. Why does this patient blink to threat bilaterally?
7. What are the different kinds of aphasia? How do we classify aphasia? What kind of aphasia
does this patient demonstrate?
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Page 3 of 21
Group 3:
A 71-year-old female with past medical history of hypertension presents to the emergency
room by her daughter due to issues with speaking. They were at church, when all of a sudden,
the patient started speaking jibberish. Her daughter states she was “unable to talk”, and she
was confused.
On examination, her pulse is irregular and tachycardic. Neurological exam reveals the patient
has spontaneous speech which is fluent, but the content is meaningless. She has paraphasic
errors and is unable to repeat words. When asked to name a chair, she states “bed”. When
asked to write down “no ifs, ands or buts”, she writes “the mans, hams and brrmmmm”. She is
blissfully unaware of her language barrier. She cannot follow commands. The patient does not
blink to threat on the right. Her muscle strength testing shows 5/5 strength throughout. Her
sensation is intact in all 4 extremities.
4. What is paraphasia?
5. Why does this patient not blink on the right?
6. What are the different kinds of aphasia? How do we classify aphasia? What kind of aphasia
is this patient demonstrating?
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Page 4 of 21
Case 4:
A 62-year-old female with past medical history of diabetes and high cholesterol is referred to
her ophthalmologist due to decreased vision. 1 month ago, she started to noticed intermittent
blurry vision, mostly in the right eye. These episodes lasted about 20 minutes, and were
accompanied by a severe headache. Yesterday, she had another episode, but this one has not
resolved, and therefore, she was referred to ophthalmology.
Neurological examination reveals the patient is alert and oriented to person, place and time.
Her cranial nerve exam reveals her pupils are equal, round and reactive to light. Her
extraoccular motion is intact. Visual field testing shows decreased vision in the right visual
fields. She has 5/5 strength throughout all 4 extremities. She has 1+ ankle reflex bilaterally. Her
coordination and gait is intact. Additionally, her sensation is intact except for loss of pinprick
sensation and vibration from the toes up to the mid-shin bilaterally.
4. Why does this patient have sparing of sensory and motor loss?
5. List the major cranial nerves that are involved in the eye. What are their purpose? Are these
cranial nerves affected in this patient case?
6. Draw and describe the visual pathways. Label the anatomic location of common visual field
defects.
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Page 5 of 21
Group 5:
A 35-year-old female presents to her PCP with left arm, face and leg weakness. She stated 3
days prior, she was at an amusement park and noticed herself bumping into walls and
buildings on the left side. She thought it was from all the rollercoaster rides. However, the next
day she developed stuttering, which resolved within 10 minutes. The day she saw her PCP, she
noticed her left arm and hand were weak and uncoordinated.
On neurological examination, the patient was alert and oriented to person, place, and time. She
was dysarthric. The patient had a decreased nasolabial fold on the left. She had 4/5 muscle
strength in the proximal muscles on the left. She had spasticity in the left arm, and fine finger
motions were slowed on the left. She had 3+ reflexes on the left hemibody, and a equivocal
Babinski sign on the left. Her finger-to-nose testing was unremarkable bilaterally. When
walking, she listed to the left, and was unable to walk in a straight line. Her sensation exam
was normal.
3. What is the vascular supply to this region?
4. What is an equivocal Babinski sign?
5. Why is sensation spared in this patent?
6. Differentiate cortical vs subcortical. Does this patient have cortical or subcortical physical
exam findings?
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Page 6 of 21
Group 6:
A 29-year-old female presents to the emergency room with sudden onset of vertigo, ataxia, left
facial numbness and hoarseness. The patient was involved in a MVA, and felt her neck “pop”.
Since then, she has left sided neck pain and headache. She also has difficulty walking because
she looses her balance, and has vomited 4 times.
On neurological examination, the patient is alert and oriented to person, place and time. She
has pupil inequality; her left pupil is smaller than the right. She has left-sided ptosis, and
decreased pinprick sensation on the left side of her face. She has a hoarse voice. Additionally,
she has decreased palate elevation on the left and a diminished gag reflex. She has 5/5
strength throughout all 4 extremities. She has dysmetria on finger-to-nose testing on left hand.
She is unable to stand or walk because of dizziness and vertigo. Additionally, she has
decreased pinprick and temperature on the right side of the body below the neck.
3. What is the vascular supply or this structure?
4. Why does this patient have decreased temperature and pain sensation on the face, hoarse
voice, diminished gag reflex, and decreased palate elevation? What cranial nerves are
involved?
5. Why does this patient have diminished pain and temperature sense on the right side of the
body and left side of the face?
6. Describe classic physical exam findings of Horner’s syndrome. Why does this patient have
Horner’s syndrome?
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Page 7 of 21
Group 7:
A 46-year-old male with past medical history of high cholesterol and hypertension presents to
the emergency department with double vision and unsteadiness. Over the past 3 days, he
developed double vision and balance issues, but did not initially seek medical care until today,
when he developed right sided facial numbness, hearing loss, and poor coordination.
Neurological examination reveals the patient is alert and oriented to person, place and time.
He has decreased sensation with pinprick on the right face, with a diminished corneal reflex on
the right. He has a right sided facial droop. He has difficulty hearing on the right side, and with
Weber test, he lateralizes to the left ear. He has 5/5 strength throughout all 4 extremities. With
ambulation, the patient has a wide based gait, and cannot walk in tandem. He has dysmetria
on finger-to-nose testing on the right. His sensation to pain and temperature is diminished on
the left side of his body.
4. What are the different components of the corneal reflex test (afferent and efferent)?
5. What is a Weber test? How is it performed? Demonstrate the Weber test.
6. Why does this patient have decreased sensation on the right side of the face? Why does he
have a facial droop?
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Page 8 of 21
Group 8:
A 55-year-old male with past medical history of unprovoked pulmonary embolism and
rheumatoid arthritis presents to the emergency room with sudden onset quadriplegia and
respiratory failure. The patient was intubated at the scene and rushed to the emergency
department.
On neurological examination, orientation was initially unable to be assessed, as the patient was
unable to speak. Cranial nerve assessment revealed he was unable to move his eyes
horizontally, and he had a negative oculocephalic reflex. Vertical eye movements were
preserved, and he was able to blink. He was able to respond appropriately to yes/no questions
by blinking or looking upwards. There was 0/5 strength in all 4 extremities. There was a positive
Babinski sign bilaterally, his reflexes were 1+ throughout. The patient was unable to move in
response to pain, but with blinking, could communicate he had feeling in all 4 extremities.
4. What is an oculocephalic maneuver? How do you test this reflex?
5. Damage to which cranial nerves will account for the patient’s eye movements?
6. Why is this patient unable to move his extremities?
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Page 9 of 21
Group 9:
A 70-year-old male with past medical history of hypertension and tobacco use developed
sudden vision issues and gait unsteadiness while watching a football game. His wife noticed he
was running into things on the right side, and he dropped the adult beverage in his right hand
when trying to drink. Once he started to get double vision and couldn’t watch his football
game, his wife took him immediately to the emergency department for evaluation.
On neurological examination, he was alert and oriented to person, place and time. The patient
refused to have his pupillary reflexes checked because of light sensitivity, but his left pupil was
dilated in room lighting. His left eye had minimal movement, but he was able to look to the left
on left-ward gaze. His left eye was oriented down and out. He also had left sided ptosis. He
had 5/5 muscle strength throughout all 4 extremities. The patient had difficulties walking in
tandem due to poor coordination, and listed to the right. At rest, he had a tremor on the right
hand. His sensation was grossly intact and symmetric in the extremities.
4. Why does the patient have this particular ocular physical examination? Which cranial
nerve(s) have been affected?
5. Why does the patient have ataxia? Why does the patient have a tremor?
6. What would you expect his pupillary response to be?
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Page 10 of 21
Group 10:
A 71-year old female with past medical history of hypertension and atrial fibrillation presents to
the ER with difficulties with vision and weakness. She was washing dishes after lunch, when
she developed weakness in the left hand and dropped a dish. She then had weakness in the
leg, and fell to the ground. Her husband called for an ambulance.
Physical examination reveals an irregular rate and rhythm. On neurological examination, the
patient’s cognition and orientation is intact. The patient has ptosis and a fixed and dilated pupil
on the right. At rest, her right eye is deviated inferior-laterally. She has a deviation of the tongue
to the left, and also has paralysis of the lower half of the face the left side. She has 3/5 strength
in the left upper and lower extremities. Her sensation is intact and symmetric in all 4
extremities.
4. Why does the patient’s tongue deviate to the left?
5. Why does this patient have left hemiparesis?
6. Why does the patient only have weakness in the lower half of the left side of her face?
7. Why is this patient at increased risk of an ischemic stroke? What tool can you use to
predict the likelihood this patient would have future ischemic strokes? How does this
influence your treatment?
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Page 11 of 21
Group 11:
A 71-year old female with past medical history of hyperlipidemia and diabetes mellitus type 2
presents to the emergency department with difficulties with vision and weakness. This
happened suddenly this morning, when she was brushing her teeth. She noticed weakness in
her right hand, a facial droop in the lower half of the left face, and difficulties moving her
tongue.
On neurological examination, the patient’s cognition and language is intact. She has a dilated
pupil and ptosis on the left. She has weakness of the facial muscles on the lower face of the
right side of her face, and her tongue protrudes to the right. She has 3/5 strength on the right
hemibody. At rest, she has a tremor in the right arm, and has difficulty with ambulation due to
ataxia. Her sensation is symmetric and intact in all extremities.
4. Why does the patient have ataxia? Why does the patient have a resting tremor?
5. Why does this patient have right hemiparesis?
6. Why does the patient only have weakness in the lower half of the left side of her face?
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Page 12 of 21
Group 12:
A 50-year-old male with history of non-valvular atrial fibrillation who takes warfarin, presents to
the emergency department midmorning for difficulties with sensory changes. The patient is a
truck driver, and noticed his right arm and leg went numb while driving. He then developed
weakness in the right arm, and fell when getting out of his semi-truck. He drove himself to the
emergency department for further evaluation.
On neurological examination, the patient has intact cognition and language. With cranial nerve
testing, his tongue points to the left when protruded. He has 4/5 strength and increased tone in
the right arm and leg. He has upgoing toes on the right. His sensation to vibration and joint
position sense is diminished on the right arm and leg.
4. Why does this patient have decreased sensation of vibration and position sense on the
right side?
5. Why does this patient have abnormal tongue movement?
6. Why does the patient have weakness on the right side?
7. Why is this patient at increased risk of an ischemic stroke? What tool can you use to
predict the likelihood this patient would have future ischemic strokes? How does this
influence your treatment?
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Page 13 of 21
Group 13:
A 83-year-old male with past medical history of a mechanical valve on warfarin is seen in the
emergency department for difficulties with vision and weakness. He is a rancher, and was out
looking after his cattle when he suddenly developed a headache, vision changes, and
weakness in the left arm and leg.
On examination, the patient has intact cognition and memory. The patient has difficulties with
abduction of his left eye when gazing to the left. He has 3/5 strength in the right arm and leg,
and slumps to the right when sitting. He has 3+ reflexes on the right hemibody. With
ambulation, he has a right hemiplegic gait, and slaps his foot hard on the ground when
walking. On sensory examination of the right side, he is unable to detect movement in the 1st
digits in the foot and hand, and is unable to tell when the vibration from the tuning fork stops.
4. Why does this patient have decreased sensation of vibration and position sense on the
right side?
5. Why does this patient have abnormal eye movement?
6. Why does the patient have weakness on the right side?
7. What is the goal INR for this patient? Why?
8. How are deep tendon reflexes graded? What levels do common deep tendon reflexes test?
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Page 14 of 21
Group 14:
A 58-year old female with 30 year history of smoking presents to the urgent care with sudden
onset of nausea, vomiting and a feeling of unsteadiness. It was July, and she had eaten at a
picnic the day before. She thought her symptoms were due to some “bad potato salad”, and
she did not receive medical attention until the next day.
On neurological examination, she has intact cognition. The patient has slurred speech and
difficulties with tongue movement and coordination. The patient has 5/5 strength in all
extremities. Additionally, the patient has dysmetria and dysdiadochokinesia in the left arm and
leg. When getting up from the exam table, the patient falls to the left due to issues with
coordination. She has a wide-based gait, and a positive Rhomberg sign. Her sensation is intact
and symmetric in all 4 extremities.
4. What physical exam maneuvers will discriminate truncal from limb ataxia?
5. How do we test dysmetria and dysdiadochokinesia? What are positive findings indicative
of? Why are these symptoms on the left?
6. How is muscle strength graded? What functional movements do physicians use in order to
test muscle strength in the arms and legs? What spinal levels do these functional
movements test?
7. What are this patient’s risk factor(s) for acute ischemic stroke?
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Page 15 of 21
Group 15:
A 16-year-old female is seen by her PCP due to vision issues for the past 2 weeks. She plays
soccer, and hasn’t been able to visualize the ball, especially when it is kicked into the air. She is
a great soccer player, and scouts have been watching her for college scholarships. On a
thorough review of systems, her PCP notes she has ammenorhea and a progressively
worsening headache over the past 2 months.
On neurological examination, the patient is alert and oriented x4. The patient is unable to look
up at the ceiling with either eye. She has large pupils that do not react to light, but did react to
near-far accommodation. Additionally, she has bilateral lid retraction. She has 5/5 strength in all
extremities. Sensation was symmetric and intact in all 4 extremities. On fundoscopic
examination, she has swelling of the optic nerves bilaterally.
3. What is the name of this syndrome?
4. What is Collier’s sign?
5. Explain the eye movement examination in this patient. What structure is damaged?
6. Explain the pupillary abnormalities in this patient.
7. What is meant by the documented “Alert and oriented x4”? What is a better way to
document this physical exam finding?
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Page 16 of 21
Group 16:
A 24-year-old female with past medical history of Lupus is seen in the emergency department
for headache and facial numbness. The patient states she had been developing frequent
headaches and sinus drainage over the past week. Suddenly, when she was working at the
local deli, she developed a severe headache and could not feel her left forehead or cheek. Her
co-worker drove her to the ED, because the patient could not move her eyes to the left, and
was getting double vision.
On physical examination, the patient has an elevated temperature of 101.5. On neurological

examination, the patient is alert and oriented x4, but distressed. Her left pupil is larger than her
right, with no response (direct or consensual) to light. Her left eye has opthalmoplegia, and
there is severe ptosis on the left. She has decreased corneal sensation in the left eye. She has
decreased sensation on the left forehead and cheek. She and 5/5 strength throughout all
extremities, and her coordination was intact. Additionally, her sensation in the extremities was
intact. While awaiting further workup in the ED, she has a tonic-clonic seizure.
2. Where is the cranial lesion? Which side?
3. What cranial nerves are affected? How are these cranial nerves all affected concomitantly
in this patient?
4. What is causing the patient’s ophthalmoplegia?
5. When documenting “Alert and oriented x4”, what does that mean? How do we examine
orientation x4 in a clinical setting?
movements test?
7. What is the best initial treatment of tonic-clonic seizure in an emergency setting?
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Page 17 of 21
Group 17:
A 18-year-old female is seen by her PCP for transient difficulties with weakness, sensory, and
visual deficits. She states this has been progressively getting worse in the past month.
On neurological examination, the patient was alert and oriented to person, place, and time. The
patient had difficulties with left eye adduction on rightward gaze. Additionally, she had end-
range nystagmus with abduction on the right eye. With convergence, the left eye was able to
adduct. Her muscle strength was 5/5 throughout all 4 extremities. She did not have any signs
of ataxia with finger-to-nose testing. Her sensation was grossly intact in all 4 extremities and
symmetric. The physician referred the patient to neurology for a second opinion.
1 week later, the patient called back and said her vision issues were getting worse. The PCP
reexamined the patient. This time on examination, in addition to the previous physician exam
findings, the patient is unable to adduct the right eye or abduct the left eye when looking left-
ward. The rest of her neurological exam is unchanged, except for dysmetria with finger-to-nose
testing on the left.
1. What are the pertinent physical exam findings on initial examination?
2. Discuss what lesion caused the initial visual disturbances.
4. What are the pertinent physical exam findings on the second examination?
5. Discuss what lesion caused the subsequent visual disturbances.
7. Discuss the neuronal pathways involved in supranuclear control of eye movements.
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Page 18 of 21
Case 18:
A 59-year-old male with past medical history of type 2 diabetes, previous MI, and hypertension
is seen by his PCP the morning after experiencing left arm weakness. He was gardening on a
particularly hot day, and had an episode of dizziness, and fainted. Afterwards, he noticed
difficulties lifting bags of dirt overhead with his left arm. He figured he was tired, so he went
home, ate dinner, and went to bed. When he woke up in the morning, he had difficulties
washing his hair due to left shoulder weakness, so he scheduled an appointment with his PCP.
On physical exam, he was noted to have a carotid bruit on the right. On neurological
examination, the patient was alert and oriented. He had 5/5 strength in the right arm, but on the
left, he had 3/5 strength with shoulder abduction, elbow flexion and extension, and 5/5
strength with finger flexion and wrist extension. In the left leg, he had 4/5 strength with hip
flexion, with the rest of his leg strength being 5/5. His right leg had 5/5 strength. He had 3+
reflexes on the left hemibody, and upgoing toes on the left. His finger to nose testing was
normal. With ambulation, the patient leaned to the left. His sensory exam was normal.
4. Why does the patient lean to the left with ambulation?
5. How do we test for a carotid bruit? Why does the patient have a carotid bruit? What
imaging would be helpful in finding the etiology of his bruit?
movements test?
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Page 19 of 21
Case 19:
A 67-year old male was referred to a ENT physician for progressive vocal changes and
weakness of the neck muscles. The patient states over the past 6 months, he has been treated
for several rounds of laryngitis, which never resolved. Additionally, he started to feel weakness
in the left side of his neck muscles in the past month. He works as a salesman, and his
coworkers have noticed his voice seems gravely and hoarse when giving sales pitches. He also
states he has difficulties with swallowing, and has lost 50 pounds in the past 6 months.
On neurological exam, the patient is alert and oriented to person, place and time. His uvula
deviates to the right. His voice is hoarse. He has weakness when looking to the left using his
neck muscles. The ENT physician performed a larynoscopic examination, which proved the left
vocal cord was paralyzed. His muscle strength was 5/5 in all 4 extremities. He had a normal
finger-to-nose test, and his sensory exam was intact and symmetric in all 4 extremities.
3. What is causing the patient horse voice and left vocal cord paralysis?
4. Why does the patient have weakness in the cervical muscles on the left?
5. Why does the patient have difficulties with swallowing?
6. What are the afferent and efferent components of the gag reflex? Why does his uvula
deviate to the right?
Page 20 of 21
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Case 20:
A 72-year-old female with no previous medical history presents to her PCP with decreased
hearing and dizziness. She recently retired as a school librarian, and states that her hearing has
progressively gotten worse over the 3 months. She is an active individual, and loves to
horseback ride. However, she has fallen off her horse several times due to dizziness and
vertigo. Additionally, she has facial pain and decreased taste on the left side of her tongue.
On neurological examination, she is alert and oriented x3. She has a decreased corneal reflex
on the left. Her facial movements are less obvious on the left side. She has decreased hearing
in the left ear in comparison to the right. A vibrating tuning fork was louder when held in the air
next to her left ear than when the tuning fork was placed on her left mastoid process. Taste
was not formally tested. She had 5/5 strength throughout all 4 extremities. Her reflexes were
2+, and she had downgoing toes. Coordination and her sensory examinations were intact. She
ambulated without difficulty.
1. What are the pertinent history/physical exam findings?
4. What different components does the corneal reflex test?
5. What hearing test is being described in the above clinical vignette? What does this
information provide?
6. What cranial nerves are affected in this patient? What physical exam findings/history
describes the cranial nerves that are damaged?
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Page 21 of 21

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ALA: Find the Lesion Group Project

Completion of this activity will fulfill the following Course Objectives:

• Objective 1: Build a comprehensive vocabulary pertaining to the anatomy, physiology and

• Objective 4: Demonstrate proficiency in using anatomical and physiological principles to

• Objective 5: Interpret the results of a comprehensive neurological examination.

• Objective 6: Demonstrate and reflect upon professional and inter-professional behaviors

Directions for ALA:

• Cases are assigned based on Clinical Small Group Number.

• Active participation of all members of the group

1. What are the pertinent physical exam findings?

2. Where is the intracranial lesion? Which side?

3. What is the vascular supply?

5. What is “dysarthria”? How is this diﬀerent from “aphasia”?

1. What are the pertinent physical exam findings?

2. Where is the intracranial lesion? Which side?

3. What is the vascular supply?

6. Why does this patient blink to threat bilaterally?

1. What are the pertinent physical exam findings?

2. Where is the intracranial lesion? Which side?

3. What is the vascular supply?

5. Why does this patient not blink on the right?

1. What are the pertinent physical exam findings?

2. Where is the intracranial lesion? Which side?

3. What is the vascular supply?

1. What are the pertinent physical exam findings?

2. Where is the intracranial lesion? Which side?

3. What is the vascular supply to this region?

4. What is an equivocal Babinski sign?

5. Why is sensation spared in this patent?

1. What are the pertinent physical exam findings?

2. Where is the intracranial lesion? Which side?

3. What is the vascular supply or this structure?

1. What are the pertinent physical exam findings?

2. Where is the intracranial lesion? Which side?

3. What is the vascular supply?

5. What is a Weber test? How is it performed? Demonstrate the Weber test.

1. What are the pertinent physical exam findings?

2. Where is the intracranial lesion? Which side?

3. What is the vascular supply?

4. What is an oculocephalic maneuver? How do you test this reflex?

6. Why is this patient unable to move his extremities?

1. What are the pertinent physical exam findings?

2. Where is the intracranial lesion? Which side?

3. What is the vascular supply?

6. What would you expect his pupillary response to be?

1. What are the pertinent physical exam findings?

2. Where is the intracranial lesion? Which side?

3. What is the vascular supply?

4. Why does the patient’s tongue deviate to the left?

5. Why does this patient have left hemiparesis?

1. What are the pertinent physical exam findings?

2. Where is the intracranial lesion? Which side?

3. What is the vascular supply?

5. Why does this patient have right hemiparesis?

1. What are the pertinent physical exam findings?

2. Where is the intracranial lesion? Which side?

3. What is the vascular supply?

5. Why does this patient have abnormal tongue movement?

6. Why does the patient have weakness on the right side?

1. What are the pertinent physical exam findings?

2. Where is the intracranial lesion? Which side?

3. What is the vascular supply?

5. Why does this patient have abnormal eye movement?