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Chapter 1. Anatomy and Physiology of the Central and Peripheral Nervous System

A previously healthy 71-year-old retired accountant was noticed by his wife to become forgetful in the past year. He was having increasing difficulties tracking his bills and remembering phone numbers and was confused when paying for groceries. neurological examination was unremarkable. He scored 22 of 30 on the Folstein Mini Mental Status Evaluation (MMSE) because he could not recall three of three objects and could not recall the current date, month, year, season, or place. Which of the following brain MRI views is compatible with the patient's diagnosis?

(A) Brain view in Figure 1-1

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Figure 1-1 Reproduced with permission Ropper AH, Samuels MA, Klein JP: Adam's & Victor's Principles of Neurology, 10th ed. New York: McGraw-Hill Education; 2014.

(B) Brain view in Figure 1-2

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Figure 1-2 (Reproduced with permission from Martin JH. Neuroanatomy Text and Atlas. 4th ed. New York: McGraw-Hill; 2012.)

(C) Brain view in Figure 1-3

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Figure 1-3 (Reproduced with permission from Martin JH. Neuroanatomy Text and Atlas. 4th ed. New York: McGraw-Hill; 2012.)

(D) Brain view in Figure 1-4

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Figure 1-4 (Reproduced with permission from Martin JH. Neuroanatomy Text and Atlas. 4th ed. New York: McGraw-Hill; 2012.)

(E) Brain view in Figure 1-5

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Figure 1-5 (Reproduced with permission from Martin JH. Neuroanatomy Text and Atlas. 4th ed. New York: McGraw-Hill; 2012.)

(A) The patient described in this vignette developed progressive loss of short-term memory compatible with the diagnosis of Alzheimer disease. The cortical and subcortical atrophy illustrated in Figure 1-1 MRI is typically seen in Alzheimer disease. In addition, there is a ventricular enlargement because of neural tissue loss. Because of extensive cortical atrophy, there is widening of the cortical sulci filled with more cerebral spinal fluid. The hippocampus is a structure responsible for consolidation of short-term to long-term memory. Its atrophy associated with temporal lobe cortex degeneration in Alzheimer disease creates a gaping hole in the temporal lobe. (Martin, 3–5)

 

Martin JH. Neuroanatomy. Text and Atlas. 3rd ed. New York: McGraw-Hill; 2003.

A 67-year-old left-handed woman presented to the emergency room with an acute onset of left-sided weakness and inability to speak. The patient had a past medical history of type 2 diabetes and uncontrolled hypertension. physical examination demonstrated left upper and lower extremity flaccid paralysis with left facial weakness. Sensory loss to noxious stimulus was noticed in the left arm, leg, and ...

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