Quiz on Lesion Localization
Q.1 A 65 year old man with ischemic heart disease (infarct) and fast atrial fibrillation (not
hematoma) presents to ER with one hour history of right sided weakness and inability to
comprehend and speak.
On examination:
Conscious
Left gaze preference
Globally aphasic
Right facial asymmetry
Right hemiplegia
Right plantar extensor
a) Where is the lesion? Left fronto temporal region
b) What is the pathology? Left large MCA infarct
Quiz on Lesion Localization
Q.2 A 12 Year old boy is finding it increasingly difficult to climb stairs, get up from squatting position
and combing hair. His symptoms have gradually worsened over the last six years. His elder
brother, who is similarly affected, is bed bound since the last one year.
On examination:
Conscious
Cranial nerves intact
Power : G3 proximally in upper & lower limbs
G4 distally in upper & lower limbs
DTRs +1 all over
No sensory loss
Plantars flexor (meaning normal?)
a) Where is the lesion? proximal muscle
b) What is the pathology? Dystrophy (Duchenes)
c) Bechers has more longevity
Quiz on Lesion Localization
Q.3 A 23 year old male is the victim of road traffic accident. He presents with left wrist drop
2 hours after fall from a bike.
On examination :
Conscious
In pain
Cranial nerves intact
Left wrist drop (wrist extension 0/5)
Left finger extension 0/5
DTR
+2 left biceps jerk,
left triceps jerk and left brachioradialis jerk not elicitable
a) Where is the lesion? radial nerve
b) What is the pathology? Nerve injury secondary to humerus fracture proximal to branch to
trciepts
Quiz on Lesion Localization
Q.4 A 48-year-old diabetic, hypertensive female presents to ER with 6 hour’s history of left sided
weakness, slurring of speech and double vision on looking to the right.
On examination:
Conscious
Right eye abduction impaired
Right facial weakness (LMN type)
Left hemiparesis
Left plantar extensor
DTRs +2 all over (acute stroke that’s why no UMN signs)
a) Where is the lesion? Right Midbrain because crossed hemiplegia. Pons because facial
b) What is the pathology? Pontine infarct
6th and 3rd cranial nerve common with diabetes pupillary nerve spared but not in aneurysm
Quiz on Lesion Localization
Q.5 A 58-year-old male presents to the clinic with slurring of speech, difficulty in swallowing liquids
and getting up from squatting position and climbing stairs. He finds it difficult to make a morsel
with his hands and to button his shirt.
On examination:
Conscious
Dysarthric speech
Gag reflex weak
Extra ocular movements full
No facial weakness
Fasciculations seen over left deltoid and right gastrocnemius (AHC)
Wasting of small muscles of hands (R>L)
Power Proximal 4/5 in upper limbs
Distal 3/5 in upper limbs
Proximal 3/5 in lower limbs
Distal 4/5 in lower limbs
DTRs +3 in upper limbs
+1 knee jerks
Bilateral ankle clonus +ve (UMN?)
Plantars extensor (UMN)
No sensory loss
a) Where is the lesion? AHC
b) What is the pathology? MND (ALS)
Quiz on Lesion Localization
Q.6 A 36 year old male developed weakness of all four limbs that involved the lower limbs first and
then in two days’ time spread to involve the upper limbs too. This weakness developed over a
period of 5-6 days following an upper respiratory tract infection.
On examination:
Conscious
Cranial nerves intact
Quadriparetic
Power 3/5 in upper limbs
Power 2/5 in lower limbs
DTRs brisk all over
Sensory level at C4
Plantars extensor
a) Where is the lesion?
b) What is the pathology?
Quiz on Lesion Localization
Q.7 A 38-year-old woman presents to the OPD with three week’s history of intermittent doubling of
vision, worse in the afternoon. At times she has noticed that there is a nasal twang to her voice
and her speech is then not clear.
On examination:
Conscious
Normal speech
Right eye - Weak abduction
Left eye - partial ptosis
Motor and sensory exam normal
a) Where is the lesion?
b) What is the pathology
Quiz on Lesion Localization
Q.8 A young epileptic girl, on Phenytoin, had a serious argument with her sister. In a fit of anger, she
overdosed herself with Phenytoin. 12 hours later she was brought to the ER with an acute onset
of vertigo, vomiting and inability to maintain her balance.
On examination:
Drowsy but arousable to verbal commands
Scanning speech
Bilateral horizontal nystagmus
Bilateral finger to nose dysmetria
Unable to maintain sitting balance
Power 5/5 in all four limbs
DTRs +2 all over
Plantars flexor
No sensory loss
a) Where is the lesion?
b) What is the pathology
Quiz on Lesion Localization
Q.9 A 60-year-old male is brought to the clinic by his wife. She states that her husband has difficulty
in walking, with a tendency to fall backwards, especially if he has to make a turning. She has also
noticed that he now spends more than the usual time in dressing and bathing.
On examination:
Conscious
Soft speech
Slow to initiate movements
Decreased arm swing
Rigidity in right upper and lower limbs
Resting tremor in right hand
Motor and sensory exam normal
Cerebellum intact
a) Where is the lesion?
b) What is the pathology
Quiz on Lesion Localization
Q.10 A 29-year-old male developed diffuse headache, frequent vomiting and low-grade fever over a
period of 3-4 weeks. One day prior to coming to the ER, his right eyelid drooped, and he started
to fall on the left side.
On examination:
Drowsy but arousable to verbal commands
Right eye - Complete ptosis
Right eye in down and out position
Right pupil dilated
Mild left facial weakness of UMN type
Mild left hemiparesis
Power 5/5 on right side
Power 4/5 on left side
DTRs brisk on left side
Left plantar extensor
Sensory exam normal
Neck stiffness +ive
a) Where is the lesion?
b) What is the pathology
