Question 4 Answers: Neurosurgery

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Eccentric topic of the Week
Question 4:

What is the most common cause of low back pain in people less than 35 years old?

A. Herniated nucleus pulposus
B. Degenerative disk disease
C. Trauma
D. Scoliosis
E. Spondylolisthesis


Answer:

E. Spondylolisthesis,

"Spondylolisthesis" refers to slippage of one vertebral body on another vertebral body, Most commonly, the superior vertebra translates forward on the inferior vertebra, causing an anterolisthesis.

The most common symptom of spondylolisthesis is low back pain Many times, a patient can develop a lesion (spondylolysis) between the ages of 5 and 7, but not present symptoms until they are 30~35 (normally after a sudden twisting or lifting motion that causes an acute episode of back and leg pain).

Degenerative diseases, such as arthritis and stress fractures, are common causes.

Traditional treatments include either a "posterior or anterior surgical approach, or a combined anterior-posterior approach", with reduction of the subluxation.

Grande I - the upper verteba has slipped forward < 25% of the total width of the vertebral body
Grade II - 25-50%
Grade III - 50 - 75%
Grade IV > 75% (if the upper vertebral body has slid all the way forward off the front of the lower vertebral body - referred to as spondyloptosis).

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Question 3 Answers: Neurology

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Eccentric topic of the Week
Question 3.

3) Regarding the trochlear nerve:

A. True: It originates from the midbrain
B. True: It is the only cranial nerve that exits from the dorsal surface of the brainstem
C. False: Its lesion results in paralysis of the inferior oblique muscle
D. True: It supplies only one orbital muscle
E. False: Its palsy causes horizontal diplopia

Answer:

The trochlear nerve innervates the superior oblique muscle. Trochlear nerve palsy (weakness of the superior oblique muscle) results in torsional (palsy causes the eye to extort) and vertical diplopia; horizontal diplopia is seen in abducens nerve palsy. To compensate for the extorsion, patients with trochlear nerve palsies tilt their heads to the opposite side, in order to fuse the two images into a single visual field (by intorsion of the normal eye).*

*Snell RS. The cranial nerve nuclei and their central connections and distribution. In: Clinical Neuroanatomy for Medical Students, 4th edition. Philadelphia: Lippincott-Raven, 1997: 406.


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Question 2 Answer: Neurology

Eccentric topic of the Week
Question 2.

Regarding the oculomotor nerve: 

A. False: It originates from the superior pons

B. True: It has many subnuclei
C. False: Pupillary-sparing palsy usually indicates a compressive lesion
D. True: It can be a false localizing sign in herniation syndromes
E. False: It is responsible for innervating the dilator pupillae

The oculomotor nerve originates from the midbrain at the level of the superior colliculus. It has two components: the somatic motor and the parasympathetic Edinger Westphal nucleus. The somatic motor component has three subnuclei: the lateral, medial, and central subnuclei (these nuclei lie at the level of the superior colliculus). The oculomotor nerve elevates the upper eyelid, turns the eyeball upward, downward, and medially; it also constricts the pupil and accommodates the eye. A compressive lesion of the oculomotor nerve produces pupillary dilation as the first sign (so-called surgical oculomotor nerve palsy); the medical oculomotor nerve palsy is pupillary-sparing (like the classical diabetic acute 3rd nerve palsy). It supplies the constrictor pupillae and ciliary muscles with parasympathetic fibers.*

*Snell RS. The cranial nerve nuclei and their central connections and distribution. In: Clinical Neuroanatomy for Medical Students, 4th edition. Philadelphia: Lippincott-Raven, 1997: 406.


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Question 1 Answer: Neurology

Eccentric topic of the Week
Question 1.

1) Regarding the optic nerve: 

A. False: It is located in the posterior fossa 

B. False: Optic neuritis causes bitemporal hemianopia
C. True: Optic nerve sheath meningioma can produce proptosis of the globe
D. True: It originates from the ganglion cells in the retina
E. False: Leber's optic neuropathy is a form of tobacco-alcohol amblyopia


Answer:


The optic nerve (together with the olfactory nerve) is located in the supratentorial compartment. Optic neuritis or other lesions can cause a variety of monocular visual field defects, from scotomas to unilateral blindness. Leber's optic neuropathy is a heritable mitochondrial disorder that causes degeneration of retinal ganglion cells.*

*Fix JD. Development of the nervous system.High Yield Neuroanatomy, 2nd edition. Philadelphia: Lippincott Williams & Wilkins, 2000: 27.

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Eccentric topic of the Week
Question 4:

What is the most common cause of low back pain in people less than 35 years old?

A. Herniated nucleus pulposus

B. Degenerative disk disease
C. Trauma
D. Scoliosis
E. Spondylolisthesis

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Eccentric topic of the Week
Question 3. 

Regarding the trochlear nerve: 

A. It originates from the midbrain

B. It is the only cranial nerve that exits from the dorsal surface of the brainstem
C. Its lesion results in paralysis of the inferior oblique muscle
D. It supplies only one orbital muscle
E. Its palsy causes horizontal diplopia


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Eccentric topic of the Week
Question 2.

Regarding the oculomotor nerve: 

A. False: It originates from the superior pons

B. True: It has many subnuclei
C. False: Pupillary-sparing palsy usually indicates a compressive lesion
D. True: It can be a false localizing sign in herniation syndromes
E. False: It is responsible for innervating the dilator pupillae

Answer:

The oculomotor nerve originates from the midbrain at the level of the superior colliculus. It has two components: the somatic motor and the parasympathetic Edinger Westphal nucleus. The somatic motor component has three subnuclei: the lateral, medial, and central subnuclei (these nuclei lie at the level of the superior colliculus). The oculomotor nerve elevates the upper eyelid, turns the eyeball upward, downward, and medially; it also constricts the pupil and accommodates the eye. A compressive lesion of the oculomotor nerve produces pupillary dilation as the first sign (so-called surgical oculomotor nerve palsy); the medical oculomotor nerve palsy is pupillary-sparing (like the classical diabetic acute 3rd nerve palsy). It supplies the constrictor pupillae and ciliary muscles with parasympathetic fibers.*

*Snell RS. The cranial nerve nuclei and their central connections and distribution. In: Clinical Neuroanatomy for Medical Students, 4th edition. Philadelphia: Lippincott-Raven, 1997: 406.


Visit:
http://www.colenpublishing.com/
for more information.

Eccentric topic of the Week
Question 1.

1) Regarding the optic nerve: 

A. False: It is located in the posterior fossa 

B. False: Optic neuritis causes bitemporal hemianopia
C. True: Optic nerve sheath meningioma can produce proptosis of the globe
D. True: It originates from the ganglion cells in the retina
E. False: Leber's optic neuropathy is a form of tobacco-alcohol amblyopia


Answer:


The optic nerve (together with the olfactory nerve) is located in the supratentorial compartment. Optic neuritis or other lesions can cause a variety of monocular visual field defects, from scotomas to unilateral blindness. Leber's optic neuropathy is a heritable mitochondrial disorder that causes degeneration of retinal ganglion cells.*

*Fix JD. Development of the nervous system.High Yield Neuroanatomy, 2nd edition. Philadelphia: Lippincott Williams & Wilkins, 2000: 27.

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http://www.colenpublishing.com/
for more information.

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