DIRECTIONS
1. You have 24 hours to answer ALL of the questions for Case 1 and Case 2.
=>Make sure you number your answers clearly and unambiguously.
2. Your answers to case 1 and 2’s questions cannot be more than a total of 4 pages double spaced
=> Full sentences & paragraphs are not required. Bullets and phrases are fine as long as you answer the questions
3. Exams are open book, but all work must be your own original work!
o No plagiarizing (see syllabus)!
o No copying, photographing or recording the questions
o No collaborations or consultations with anyone else
o No posting or discussing questions/answers with anyone else
o Anyone caught PLAGIARIZING OR GIVING or RECEIVING help on a test will get a zero for the test. Furthermore, depending on the egregiousness of the plagiarism, I reserve the right to give you and F for the course and/or notify your dean about the plagiarism.
4. You MUST submit your answers via Assignment 2 using the Turnitin feature.

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CASE 1
History. An 85-year old right-handed woman with a history of hypertension, diabetes and angina called 911 because she suddenly had difficulty talking and her right arm felt “odd.” When the paramedics arrived and asked her questions, she could understand and give single word answers. However, she could not combine words into sentences that had normal prosody and grammar (A). She also occasionally used the wrong words. For example, in explaining that she couldn’t grab with her right hand, she said “grape” instead of “grab” (B). She also told the paramedics that she could not feel things with her right arm, and that it felt “numb.” Finally, she said her vision seemed blurry on the right side but could not explain in greater detail.

Neurological Exam.
Mental status. By the time she seen by a neurologist in the emergency room 2 hours later, she was alert and knew who she was, where she was, and what day it was (“oriented x 3”). She could do simple math problems and serial 7’s. She was able to repeat 4 words and then remember then 5 minutes later.
Language. Her speech was now fluent and she could name things, repeat things and answer questions in full sentences with normal prosody, but she continued to occasionally substitute words (C) and had difficulty reading (D) and difficulty writing (E).
Cranial nerves. She didn’t cooperate with visual field testing, but she seemed to have difficulty seeing things on her right side (F). Her eye movements were normal, and she had normal facial sensation. Her smile was symmetrical and her tongue was midline.
Motor: She had mild right pronator drift and normal muscle strength in all 4 limbs.
Reflexes/Coordination. Her reflexes were normal as was her upper body coordination (finger to nose) and lower body coordination (heel to shin).
Sensory. She had normal light touch sensation and pinprick sensation in all 4 limbs. She was able to recognize objects placed in her left hand through touch alone, but she was not able to do so when objects were placed in her right hand (G). She was also able to recognize without looking when people drew letters or numbers on her left hand but not when they did it on her right hand (H). She could feel when someone touched either her right hand or her left hand, but when someone touched both hands simultaneously, she did not feel the touch on her right hand (I).

Case 1 questions
What are the names for underlined symptoms/conditions? Please use letters (A-I) to refer to symptoms/conditions.
What lesions could cause these symptoms/conditions? Please use letters to refer to symptoms/conditions.
Considering the WHOLE clinical picture, where do you think the lesion is? Explain your reasoning. [HINT: don’t just think about what is abnormal. Think about what is normal!]
Which of the attached 5 MRI scans is most consistent with your diagnosis? Explain your answer. (WARNING: The white R on the bottom left corner of each scan indicates that the left side of the image is the RIGHT side of the brain. Similarly, the white L on the bottom right corner of each scan indicates that the right side of the image is the LEFT side of the brain.)
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CASE 2
History. An 80-year old right-handed man went to the emergency room because he was experiencing strange visual problems. He had a history of a stroke 6 years previously that resulted in a homonymous scotoma in the left inferior quadrant (A)

On the day prior to admission to the hospital, while driving his car, he felt that his motion perception was off because he almost hit a car that stopped in front of him (B). He then encountered a close friend on the street, who began walking next to him, but his friend look unfamiliar. He said, “His facial features were moving all around his face. I couldn’t put it together. I know this guy like I know my brother.” The patient said to the friend, “Who are you?” and the friend answered, “What are you talking about? You’ve know me for years!” The patient then recognized him, by his voice.

Neurological Exam. In the emergency room, the patient had normal mental status, including naming presidents back to JFK and remembering 4 words at 5 minutes. He had normal visual fiends except for a homonymous scotoma in the left inferior quadrant that was unchanged from 6 years ago. He also had difficulty recognizing faces (C). For example, when shown a picture of Jimmy Carter, he said, I think should know him” but couldn’t recognize him. When shown a picture of Ronald Reagan, he said, “Get that thing away from me!” (The patient was a self-declared “flaming liberal.”) He was able to recognize objects other than faces, his ability to read and write were normal, and his color vision was normal. All of the rest of the neuro exam was normal. The patient was admitted to the hospital where he received blood thinners.
Postscript: The patient’s ability to recognize faces improved over the course of several weeks.

Case 2 questions
What is the name for condition A?
The numbers 1- 7 on the schematic drawing given in the attached file “Visual_Defect.jpg” represent possible locations of visual tract lesions. Which number is most likely the cause of condition A?
What is the name for condition B?
What is location of the lesion sometimes results in condition B
What is the general name for disorders in which language and basic visual perception is intact, but object recognition is impaired?
What is the specific name for condition C?
What is the most likely location of the lesion associated with condition C?
Which of the attached 5 MRI scans is most consistent with Case 2’s clinical history? Explain your answer. (WARNING Remember the left side of the MRIs depict the right hemisphere of the brain.).