Friday, July 17, 2009

Question 11


Source: Professor Yasser Metwally, 2008)


An 85 year old male patient is brought to the clinic from the nursing home with symptoms of abnormal movement. He has recently completed a course for Tubeculous meningits for 9 months. He has no neck stiffness or fever. The neurological examination shown above in the media suggests a lesion in the brain which may be due to previous TB infection. Most likely, where should be the lesion located?


A) Occipital Lobe
B) Wernickes area
C) Brocas area
D) Subthalamic nuclei
E) Cerebeller tonsils
F) Cardiac vegetations
G) Trinucleotide repeat disorder in caudate


For Answer click comments

1 comments:

Usmle Challenger July 18, 2009 at 1:18 AM  

Answer: D) Subthalamic Nuclei: Hemiballismus

Points to note:
Hemiballismus is a movement disorder caused by lesion in the contralateral subthalamic nucleus. Flinging, violent unliateral movement of the limb is seen when there is lesion in the subthalmic nuclei and/or its connection. Tuberculoma arising from tuberculous meningitis may be rare cause. Fortunately, it is not a common cause in the United States. Other causes for hemiballismus are stroke, non ketotic coma, traumatic injury and neoplasm. Dopamine antagonists are tried and used successfully (eg: chlorpromazine, pimozide, etc.).

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