ABCN Neuropathological Conditions and Clinical Presentations 2 — Questions and Answers
Question 1: According to standard classification criteria, a traumatic brain injury is classified as 'severe' when the post-resuscitation Glasgow Coma Scale score is:
- 13–15
- 9–12
- 3–8 (Correct answer)
- Below 3
Correct answer: 3–8
Severe TBI is defined by a GCS score of 3–8, reflecting profound impairment of consciousness at the time of injury.
Question 2: Following mild traumatic brain injury (concussion), which neuropsychological domain demonstrates the most consistent acute-phase impairment?
- Processing speed and sustained attention (Correct answer)
- Visuospatial construction abilities
- Language production fluency
- Long-term semantic memory retrieval
Correct answer: Processing speed and sustained attention
Processing speed and attention are the most reliably impaired cognitive domains in the acute and subacute phases after mild TBI, reflecting disrupted neural efficiency.
Question 3: Post-stroke aphasia characterized by non-fluent speech output, impaired repetition, and relatively preserved auditory comprehension is most consistent with which syndrome?
- Wernicke's aphasia
- Broca's aphasia (Correct answer)
- Conduction aphasia
- Transcortical sensory aphasia
Correct answer: Broca's aphasia
Broca's aphasia involves non-fluent, effortful output with impaired repetition and relatively preserved comprehension due to lesions in the left posterior inferior frontal gyrus.
Question 4: A patient with left temporal lobe epilepsy is most likely to demonstrate which selective memory impairment on neuropsychological testing?
- Impaired visuospatial memory with preserved verbal learning
- Impaired verbal learning and recall with relatively preserved visuospatial memory (Correct answer)
- Generalized amnestic syndrome affecting all modalities equally
- Prospective memory deficit without retrograde impairment
Correct answer: Impaired verbal learning and recall with relatively preserved visuospatial memory
Left temporal lobe epilepsy disrupts the language-dominant hippocampus and surrounding cortex, producing selective verbal memory deficits while visuospatial memory, subserved by the right hemisphere, remains relatively intact.
Question 5: Which neuropsychological measure is considered most sensitive for detecting left hippocampal dysfunction in temporal lobe epilepsy presurgical evaluation?
- Trail Making Test Part B
- Rey-Osterrieth Complex Figure delayed recall
- California Verbal Learning Test (CVLT) delayed recall (Correct answer)
- Digit Span Forward
Correct answer: California Verbal Learning Test (CVLT) delayed recall
Verbal list-learning measures such as the CVLT are highly sensitive to left hippocampal dysfunction because they tax the encoding and consolidation processes dependent on left medial temporal structures.
Question 6: A patient sustains a right hemisphere ischemic stroke. Which constellation of deficits is most expected on neuropsychological examination?
- Expressive aphasia, right hemiplegia, and right homonymous hemianopsia
- Left hemispatial neglect, constructional apraxia, and left hemiplegia (Correct answer)
- Alexia without agraphia and right visual field defect
- Ideomotor apraxia and Gerstmann syndrome
Correct answer: Left hemispatial neglect, constructional apraxia, and left hemiplegia
Right hemisphere strokes commonly produce left hemispatial neglect, impaired constructional abilities, and left-sided motor and sensory deficits rather than aphasia.
Question 7: The Wada test (intracarotid sodium amobarbital procedure) is administered during epilepsy surgery evaluation primarily to determine:
- Seizure type and ictal propagation pattern
- Language lateralization and adequacy of contralateral memory (Correct answer)
- Degree of hippocampal sclerosis on MRI
- Responsiveness to antiepileptic medication
Correct answer: Language lateralization and adequacy of contralateral memory
The Wada test temporarily inactivates one hemisphere to establish language dominance lateralization and to assess whether the contralateral hemisphere can support memory after resection.
ABCN Neuropathological Conditions and Clinical Presentations 2
According to standard classification criteria, a traumatic brain injury is classified as 'severe' when the post-resuscitation Glasgow Coma Scale score is: