Which of the following is true with respect to pseudobulbar palsy?
C. Pseudobulbar palsy is also known as spastic bulbar palsy. It usually results from bilateral frontal damage. This may be due to vascular, demyelinating, or motor neurone disease (amyotrophic lateral sclerosis). Diffuse brainstem damage (bulb) will produce lesions in the cranial nerve nuclei, causing bulbar palsy. Pseudobulbar palsy is an upper motor neurone type of lesion. Bulbar palsy produces lower motor neurone damage. Hence increased tone (producing spastic tongue), exaggerated tendon refl exes (brisk jaw jerk), and lack of fasciculations are notable. Diffuse frontal damage may produce frontal release signs. Poliomyelitis, diptheria, and Guillain–Barré syndrome are known causes. The most common cause of progressive bulbar palsy is motor neurone disease.
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Lesions of the subthalamic nucleus are associated with:
B. Lesions of the subthalamic nucleus are associated with hemiballismus. Lesions of the caudate nucleus are associated with chorea. Disturbances in the GABA system of caudate nucleus are noted in Huntington’s disease. Similarly, damage to the caudate nucleus is implicated in Sydenham’s chorea seen in streptococcal infection. Parkinsonian movement disturbances, especially bradykinesia, are associated with damage to the substantia nigra.
Which of the following neuropsychological tests is primarily used to detect errors in set-shifting capacity?
C. Set shifting is an executive function. In the Wisconsin Card Sorting Test, abstract reasoning and flexibility in problem solving are tested. In this test, cards of different colour, form, and number are available. Patients are asked to sort the cards into groups according to varying categories (colour only, form only, or number only) as requested by the examiner. This measures the capacity for abstract thinking and set-shifting ability (cognitive flexibility). Tower of London is a problem-solving test; it involves frontal and basal ganglia function but does not directly test set-shifting ability. Rey Osterrieth figure is a test of visual memory wherein a complex geometric figure is given to be copied, followed by immediate reproduction from memory and reproduction after a delay.
A 72-year-old man is afflicted with stroke. He is not able to identify objects with their correct names but is able to demonstrate the usage correctly. When the correct name is given to him, he is able to recognize it correctly.
He is suffering from:
C. Anomic (or nominal) aphasia presents with inability to name objects and body parts. Patients have fluent speech, intact repetition, intact comprehension, reading, and writing. Nominal aphasia often presents together with, or may follow, recovery from other forms of aphasia. Nominal aphasia is not very useful for lesion localization. It is also noted in early Alzheimer’s disease.
The blood supply to the hippocampus comes from the:
D. The blood supply to the rostral third of the hippocampus comes from the anterior choroidal artery, which is a direct branch of the internal carotid artery. It does not take part in the circle of Willis anastamosis. The occipital two-thirds are supplied by hippocampal branches, the posteromedial choroidal artery, and the inferior temporal branches of the posterior cerebral artery.
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