Pattern recognition · Neuroanatomy
Neurological Syndromes MCQ
The pattern-recognition payoff: Brown-Séquard, ASA infarct, MCA/ACA/PCA strokes, brainstem lesions, cerebellar syndromes, and the aphasias. Each one tied back to the anatomy from the brain, spinal cord, and autonomic modules. 25 board-style MCQs plus 9 INBDE patient cases.
25 practice MCQsQuick-reference tableMnemonics + clinical pearlsFull distractor explanations
High-yield review
Concept summary and clinical relevance.
Quick-reference structure first, then detailed coverage. Mnemonics in amber, clinical pearls in blue.
Neurological syndromes are how the INBDE actually tests neuroanatomy: a brief patient case plus a request to localize the lesion. This module is the pattern-recognition payoff for everything in the brain, spinal cord, and autonomic modules: vascular territories, brainstem nuclei, cerebellar laterality, and the aphasia patterns that get asked over and over.
Stroke syndromes by vascular territory
| Artery | Classic deficit | Side |
|---|---|---|
| MCA (dominant, usually left) | Aphasia + face/arm hemiparesis | Contralateral motor; language deficits independent of side |
| MCA (non-dominant, usually right) | Hemineglect + face/arm hemiparesis | Contralateral motor + ignores left side of space |
| ACA | Leg > arm weakness; abulia | Contralateral |
| PCA | Homonymous hemianopia (often macular sparing); rarely prosopagnosia | Contralateral visual field |
Brainstem cranial nerve syndromes
| Brainstem level | CN deficit | Classic finding |
|---|---|---|
| Midbrain | CN III palsy | Ptosis, “down and out” eye, dilated pupil |
| Pons | CN V and VII palsy | Loss of facial sensation/mastication; facial droop |
| Pons | CN VI palsy | Inability to abduct eye |
| Medulla | CN IX, X, XII deficits | Loss of gag, hoarseness, tongue deviation; respiratory failure if severe |
Spinal cord syndromes
| Syndrome | Pattern |
|---|---|
| Brown-Séquard (hemicord) | Ipsi motor + ipsi vibration; contra pain/temp (1–2 levels below) |
| Anterior spinal artery (ASA) infarct | Bilateral motor + pain/temp loss; vibration spared |
| Posterior spinal artery (PSA) infarct | Vibration/proprioception loss in isolation |
| Central cord syndrome | Bilateral pain/temp loss; motor + vibration spared |
Clinical pearl, Aphasia in the operatory
If a patient suddenly produces fluent but meaningless speech and can't follow commands, that's Wernicke's aphasia. If speech is halting and effortful but they understand you, that's Broca's. Either is a stroke until proven otherwise: call EMS, document time of onset (last known well), and don't wait to see if it resolves.
Clinical pearl, Cerebellar lesions are ipsilateral
Unlike the cortex (where deficits are contralateral), cerebellar lesions produce ipsilateral signs because the cerebellum's input/output crosses twice. A right cerebellar hemisphere lesion → right-sided intention tremor and dysmetria. Vermis lesions affect trunk and gait.
Clinical pearl, Stroke recognition matters in dental practice
Sudden facial droop, slurred speech, unilateral weakness, or vision change in a patient = call EMS immediately. Document the last-known-well time, that's the clock thrombolytic eligibility runs on. Don't try to “wait it out” between procedures.
Mnemonic, Stroke vascular territories
“MCA = Mouth, ACA = Ankle, PCA = Picture.” MCA = face/arm + language. ACA = leg. PCA = vision.
Mnemonic, Brown-Séquard triangle
“Ipsi motor + ipsi vibes, contra pain.” Hemicord lesion gives ipsilateral motor + vibration loss with contralateral pain/temperature loss.
Mnemonic, Aphasia in two phrases
Broca's = Broken speech. Wernicke's = Word salad. Comprehension intact in Broca's; impaired in Wernicke's.
Cortical stroke syndromes
- MCA territory: face and arm hemiparesis with cortical signs. Dominant hemisphere → aphasia (Broca's, Wernicke's, or global). Non-dominant hemisphere → hemineglect.
- ACA territory: contralateral leg weakness > arm; may produce abulia (loss of motivation/initiative).
- PCA territory: contralateral homonymous hemianopia, often with macular sparing. Rare: prosopagnosia from fusiform gyrus involvement.
Brainstem syndromes
- Midbrain: CN III palsy (ptosis, “down and out” eye, dilated pupil).
- Pons: CN V (facial sensation/mastication) and CN VII (facial expression) deficits; CN VI palsy → inability to abduct.
- Medulla: CN IX/X/XII deficits → swallowing/voice issues, tongue deviation. Severe medullary lesions threaten respiration.
Cerebellar syndromes
- Cerebellar lesions cause ipsilateral signs (the pathway double-crosses).
- Vermis: wide-based, “drunk” gait; trunk ataxia.
- Hemispheres: ipsilateral intention tremor, dysmetria, dysdiadochokinesia.
- Flocculonodular lobe: balance and eye movement disturbance.
Spinal cord syndromes
- Brown-Séquard (hemicord): ipsi motor + vibration loss, contra pain/temp loss 1–2 levels below.
- ASA infarct: bilateral motor + pain/temp loss; vibration/proprioception spared.
- PSA infarct: isolated bilateral vibration/proprioception loss.
- Central cord syndrome: bilateral pain/temp loss with motor + vibration spared.
Core Recall Check
25 board-style MCQs.
Active recall is the highest-yield study method. Pick an answer, check it, and read why every distractor is wrong.
0 of 25 answered · 0 correct
Keys: A-E or 1-5, Enter to check
- Question 1EasyA lesion affecting only one half of the spinal cord is called:
- Question 2ModerateIn Brown-Séquard syndrome, which function is lost contralaterally below the lesion?
- Question 3ModerateAnterior spinal artery infarct classically spares which sense?
- Question 4ModerateStroke in which artery is most likely to cause aphasia in a right-handed patient?
- Question 5ModerateStroke in the anterior cerebral artery (ACA) most often causes:
- Question 6EasyWhich stroke syndrome causes contralateral visual field loss with preserved motor strength?
- Question 7ModerateNon-dominant (right, in right-handers) MCA stroke is most likely to cause:
- Question 8ModerateWhich cranial nerve deficit is most typical of a midbrain lesion?
- Question 9ModeratePontine lesions often cause deficits in which cranial nerves?
- Question 10EasyCerebellar lesions produce deficits on which side of the body?
- Question 11EasySudden facial droop and inability to produce speech, but with intact comprehension, suggests:
- Question 12ModerateA patient speaks fluently but produces meaningless “word salad” and cannot follow simple commands. This is:
- Question 13ModerateA large dominant-hemisphere MCA stroke leaves a patient unable to produce speech and unable to comprehend it. This is:
- Question 14ModerateA patient has ptosis, a dilated pupil, and an eye resting “down and out.” Which cranial nerve is affected?
- Question 15ModerateA patient reports horizontal double vision and cannot move one eye laterally (cannot abduct it). Which cranial nerve is involved?
- Question 16ModerateA medullary stroke leaves the tongue deviating to the left on protrusion, with hoarseness and difficulty swallowing. Which cranial nerves are involved?
- Question 17ModerateA patient has ptosis, a constricted pupil (miosis), and decreased sweating on one side of the face. This triad is:
- Question 18HardA patient cannot wrinkle the forehead, close the eye, or smile on the entire right side of the face, with no limb weakness. This points to:
- Question 19ModerateA patient has a wide-based, staggering gait and truncal instability but normal strength and normal finger-to-nose testing. The lesion is in the:
- Question 20HardA patient has loss of pain/temperature on the left face and the right body, with hoarseness, vertigo, and ipsilateral limb ataxia after a stroke. This crossed pattern is:
- Question 21HardAfter a basilar artery stroke, a patient is quadriplegic and mute but fully conscious and able to move the eyes vertically and blink. This is:
- Question 22HardA patient has equal weakness of the contralateral face, arm, and leg with no sensory loss, neglect, or aphasia. The most likely lesion is:
- Question 23HardA patient develops complete loss of all sensation on the contralateral half of the body with no weakness. The lesion most likely involves the:
- Question 24HardA young patient loses pain and temperature sensation in a bilateral “cape” distribution over both shoulders, with intact strength and light touch. The most likely diagnosis is:
- Question 25HardA right-handed patient suddenly has right facial droop that spares the forehead, right arm and leg weakness, and non-fluent speech. The lesion is:
Clinical Reasoning Cases
INBDE patient cases.
9 ADA INBDE-format patient cases on neuro syndromes. Each case is a shared patient box plus linked questions with full distractor explanations.
INBDE Patient Cases
Neuro Syndromes INBDE Patient Cases →
9 patient cases · 45 linked questions
Open cases →
Author
Dr. Isaac Sun, DDS
Founder, KYT Dental Services. These MCQs are reviewed by a practicing clinician and offered as an educational reference for dental students.
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