Kbank question: Where's the location of the lesion? - USMLE Forums
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Old 03-15-2012
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Neuro Kbank question: Where's the location of the lesion?

A 68-year old man comes to the doc with progressive difficulty walking and headaches. He has smoked 2 packs a day for 29 years. He walks as if he's drunk. He has a wide-based, unsteady gait and a tendency to fall to the right. There are no abnormalities on finger-to-nose or heel-to-shin testing and rapidly alternating movements are normal. A lesion in which of the following structures is most likely responsible for this patient's symptoms?

A. fornix
B. corpus callosum
C. thalamus
D. midbrain
E. pons
F. medulla
G. cerebellum.
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I'm thinking...

G. cerebellum

And he's falling toward the side of the lesion?
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its thalamus..since the tests(all are cerebellar function tests) are normal..we can say cerebellum is normal..so leaves us with basal ganglia and thalamus only..thalamus...is the answer for sure
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Damn, I rushed the answer. Would the thalamus also have sensory loss or no?
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remember that thalamus INITIATES movement
and cerebellum..continues
globus pallidus and basal ganglia of thalamus they initiate movement.
this person HAS MOVEMENT!..BUT ITS JUST UNSTABLE WHICH WOULD INDICATE CEREBELLAR PROBLEM!
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pons i guess
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Old 03-16-2012
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Quote:
Originally Posted by whatsupdoc7 View Post
Damn, I rushed the answer. Would the thalamus also have sensory loss or no?
yeah probably yes..but the qs doesnot also say that the person didnot have sensory loss..so i guess thalamus is the answer..what say
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Quote:
Originally Posted by shafaliMD View Post
remember that thalamus INITIATES movement
and cerebellum..continues
globus pallidus and basal ganglia of thalamus they initiate movement.
this person HAS MOVEMENT!..BUT ITS JUST UNSTABLE WHICH WOULD INDICATE CEREBELLAR PROBLEM!
i never heard a book that says basal ganglia is a part of thalamus and globus pallidus is a part of basal ganglia..its pretty much clear that the patient has negetive cerebellar symptoms....so cerebellum cannot be the answer here..waiting for dr.nick to supply the answer
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I'd say fornix......
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the answer is Cerebellum

but I cant understand why since the tests for cerebellar function (finger-to-nose or heel-to-shin testing and rapidly alternating movements) are normal.

anybody care to explain?
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Quote:
Originally Posted by Dr.NickRiviera View Post
the answer is Cerebellum

but I cant understand why since the tests for cerebellar function (finger-to-nose or heel-to-shin testing and rapidly alternating movements) are normal.

anybody care to explain?

This Q was so unfair...
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absolutely unfair qs..those tests are cerebellar function tests..now i know why people prefer UWORLD to kqbank
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[QUOTE=Dr.NickRiviera;102847]the answer is Cerebellum

but I cant understand why since the tests for cerebellar function (finger-to-nose or heel-to-shin testing and rapidly alternating movements) are normal.

anybody care to explain?[/QUOT

bcz its due to the lesion of vermis ..vermis is involvd in balance.
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Well its correct its cerebellum .........

yes a tricky Qs but all from FA .....

Medial Cerebellum lesion truncal ataxia no defect in voluntary movements

Lateral cerebellum lesion voluntary movement lesion .

so the tests described above show that the lateral side is normal but medial side is affected .....

Its not thalamus becoz that leads to thalamic syndrome ... all sensory loss , not related to motor imbalance ...... sensory ataxia occurs at night when there is loss of visual support above are classical symptoms of cerebellar ataxia .......
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[QUOTE=Learner;102898]
Quote:
Originally Posted by Dr.NickRiviera View Post
the answer is Cerebellum

but I cant understand why since the tests for cerebellar function (finger-to-nose or heel-to-shin testing and rapidly alternating movements) are normal.

anybody care to explain?[/QUOT

bcz its due to the lesion of vermis ..vermis is involvd in balance.
Yes... and this is where Dr. Nick got me: "Vermis"... "Fornix"... that was on purpose I went trough the Q too fast, I'm still having that problem and is making me crazy!!!
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