A 67-year-old business man is admitted to a stroke unit. He is having signifi cant aphasia. He has episodes of anger outburst when someone tries to communicate with him.
Which of the following is false regarding this ‘catastrophic reaction’?
C. Goldstein instigated the term ‘catastrophic reaction’ to describe a cluster of symptoms characterized by aggressive outbursts in patients with brain injury. It was ascribed to the inability of the person to cope with the physical/cognitive deficit. An important study with respect to catastrophic reaction was conducted by Starkstein et al. in 1993. The major findings of this study are as follows. Catastrophic reaction occurs in around 20% of stroke patients. It is associated with a personal and family history of psychiatric illness. It is also significantly associated with the presence of poststroke depression. It is more common in anterior subcortical lesions and lesions involving the basal ganglia. The reaction is not merely a frustration reaction to the presence of aphasia or cognitive deficits; it could be present as a symptom on its own or as a behavioural symptom in a subgroup of depressed patients with anterior subcortical damage.
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Which of the following statements about poststroke depression is true?
B. On the basis of the fact that not all patients with a left anterior or a right posterior lesion develop depression, other premorbid factors were studied by Starkstein et al. Along with the presence of family history of affective disorders in those who developed post-stroke depression, they also found that there was no significant relationship between the presence of depression and demographic variables such as age, sex, education, socioeconomic status, etc. Presence of premorbid cortical atrophy was found to be a risk factor for depression. Similarly, cortical atrophy also predicts mania.
A 67-year-old patient with stroke has left inferior quadrantanopia, left hemineglect, and dressing apraxia with mild hemiparesis on neurological examination.
Which artery is most likely to be involved in the stroke?
B. The middle cerebral artery supplies most of the cortical grey matter, including the parietal cortex. The inferior parietal lobe includes the upper part of the optic radiation which carries fibers from upper half of the retina and hence lesions of this area produce inferior quadrantanopia. Parietal lobe damage also explains the hemi-neglect, mild hemiparesis, and dressing apraxia. Carotid artery syndrome usually presents with amaurosis fugax, the feature distinguishing it from the middle cerebral artery syndrome. Amaurosis fugax is transient, painless monocular blindness, usually due to emboli either from the large arteries or the heart itself. Occlusions of the coronaries usually occur at the bifurcation of the common carotid.
Which of the following stages of sleep is characterized by more than 50% delta activity in the EEG?
D. Stage 4 NREM sleep is characterized by more than 50% delta activity. When the delta activity ranges from 20 to 50%, the person is in stage 3 NREM sleep. K complexes and sleep spindles along with delta waves of less than 20% is noted in stage 2. Stage 2 is also the longest sleep stage through the night, comprising almost 50% of adult sleep. Stage 1 is characterized by gradual slowing of the alpha wave (less than 50% alpha activity). This is the sleep onset. Stage W (wakefulness) is characterized by predominantly alpha waves posteriorly with low voltage mixed frequency beta waves anteriorly. REM sleep constitutes around 20–25%. Normally, much less time is spent in stage W and stage 1.
All the following are features of REM sleep except:
A. Characteristics of REM sleep include variable heart and breathing rate, high oxygen consumption and cerebral blood flow, penile erections (morning erections due to high levels of REMs), increased vaginal blood flow and uterine activity, absent electrodermal activity, poikilothermic state, and dream-like mental activity. In contrast, NREM sleep is characterized by regular, slow heart and breathing rate, low cerebral blood flow and O2 consumption, absent penile blood flow, and thought-like mental activity. Muscular tone is maintained in NREM sleep and atonia is seen in REM.
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