Special Sub-Topic: Neurology and Psychiatry Click Here To Play: Neurology and Psychiatry

Which two parts of the brain are divided by the tentorium cerebelli?

The cerebellum and the occipital lobe. The cerebellum and the occipital lobe of the cerebrum are divided by the tentorium cerebelli. The left and right cerebral hemisphere are connected via the corpus callosum and divided by the fissura longitudinalis cerebri. The pons and the medulla are both structures within the brain stem. Roughly it can be said that the brain stem and the cerebellum are divided by the aquaeductus mesencephali, tectum mesencephalicum and canalis centralis.

The emergency room doctor has requested you, a neurologist, to see a 60 year old patient who, for the last 4 hours, has all the symptoms of an acute stroke. You conduct a neurological examination and find weakness and loss of sensitivity in the right leg and a very subtle weakness of the right arm. The CT-scan shows nothing out of the ordinary so you diagnose the patient with a cerebral infarction. Which therapy is most useful in this state of an acute cerebral infarction?

Aspirin. Since the CT-scan gives no indication which artery was responsible for the infarction, a carotid endarterectomy seems useless. Anti-hypertensive are a good treatment for patients who suffered an infarction, but they are not the indicated therapy in an acute situation. At this moment, you want to decrease the viscosity of the blood, which aspirin - according to most recent studies - is better at than heparin.

As a stroke patient is recovering, you call an intern to your office and decide to test her knowledge on brain infarctions. You ask her which is the main cause of a cerebral infarction. While she is nervously thinking of the answer, you are trying to remember the correct answer yourself as well. You do know it's any of the following four, but do you remember which?

Thrombo-embolism from the arteria carotis or the arteria vertebralis. 70% of all brain infarctions are caused by atherosclerosis. 30% of these cases are because of an embolism from the a. carotis or a. vertebralis, whereas 15% of these cases are caused by an emboly from the heart.

Which cells produce the myelin capsule which surrounds the axons in the central nervous system?

Oligodendrocytes. Oligodendrocytes, one of the three types of glia cells of the brain, produce the myelin capsules surrounding the axons in the central nervous system. Outside the central nervous system (the peripheral nervous system), this task is performed by the Schwann cells.

In a medical faculty somewhere in Europe, two top students are trying to impress the head of the neurology department by showing off their knowledge. Günther von Schmartaschen claims that the status epilepticus consists of convulsions that last longer than 30 minutes. Heidi Knausital says that intermittent convulsions without recovery of consciousness in between the convulsions are part of the definition of status epilepticus. Which of the following options is correct?

Both Heidi and Günther studied hard enough, since neither one was wrong. Since both Heidi and Günther were correct, the neurologist opted for Hans in the end. Hans' grades weren't quite as good as Heidi's or Günther's, but the neurologist prefers someone who is eager to learn over people who think they know it all and are in danger of becoming over-confident.

In the Stroke Unit you see a patient with a total paralysis of the right leg and a light paralysis of the right arm . The nurse tells you the patient suffered a cerebral infarction. She asks you if you can predict where in the flow area of which cerebral arteria this infarction occurred. What do you answer her?

Of course I can, it's located in the arteria cerebra anterior sinister. The loss of function of the right arm and leg suggests a loss of cerebral function in the frontal lobe of the left hemisphere. This gets its blood supply from the left arteria cerebri anterior.

A mother visits the family doctor to complain about the aggressive and hyper-energetic behaviour of her thirteen year old son. After a thorough examination the doctor thinks the child might be autistic. However, he sends the mother home without a diagnosis. Why does he do that?

Because he needs more informants than the mother alone to diagnose autism. At 13, the son's parents are allowed to be informed of the illnesses the boy may have. Autism can only be diagnosed after a thorough examination with the boy and several heteroanamnesis (e.g. conversations with the parents and teachers). General practitioners are allowed to set a psychiatric diagnosis.

The boy turned out to be autistic indeed. His parents cannot handle his aggressive behaviour any longer and ask you, their family doctor, to prescribe medication. After some hesitation, you eventually give in and write a prescription. Which of the following medicines is usually effective for the aggressive behaviour of autistic children?

Antipsychotics (e.g. haloperidol-Haldol). Only antipsychotics can help in this case. SSRI stands for 'selective serotonin reuptake inhibitor' and are powerful anti-depressives.

Someone who attempts to commit suicide is often suffering from a psychiatric disease. Which disorder is most commonly found in people who attempt to commit suicide?

Personality disorder. Schizophrenia is the third most found disorder with males who attempted to commit suicide (alcohol abuse is second), whereas depression is the second most found disorder in their female counterparts.

A 35 year old patient is diagnosed with a depressive disorder. That means she had several of the nine known criteria for depression for at least two weeks. Seven of the nine criteria are known as the 'minor criteria'. Feeling down and sad is one of the two main criteria. What is the other?

Anhedonia. Depressed people usually see their appetite fade out. This might explain their loss of energy, though their lack of good sleep, caused by the typical symptom of not falling asleep easily and waking up early in the morning, might also be responsible for this. These three criteria are all minor criteria for depressions. The correct answer was 'anhedonia'. Anhedonia means the loss of interest in anything a patient does.