Neuro Case Study With Answers

by Ralph F. Jozefowicz, MD, and Robert G. Holloway, MD, 230 pp, ill, Philadelphia, F.A. Davis, 1999, $24.95

This book, designed for first-year medical students, was developed from case studies used at the University of Rochester as part of the first-year Neural Science course. It consists of 27 brief case studies designed to teach clinical–anatomic correlation. Each case is preceded by definitions of key clinical terms and followed by a series of questions, with detailed answers supplied by the authors.

The book is very easy to read, and does an excellent job of covering the most important areas of neuroanatomy and neurophysiology concisely. More importantly, it accomplishes this in a clinically relevant fashion that will remind medical students that there is some practical use to the many details of neuroanatomy that they have been working so hard to learn. Cases include “The burned barbecue chef,” with syringomyelia, “The tremulous dentist,” with PD, “The blind beautician,” with MS, and so on. Other covered topics include herniated disks, lateral medullary infarct, middle cerebral artery infarct, ALS, Huntington’s disease, acoustic neuroma, pituitary adenoma, epilepsy, and AD. Cases are often accompanied by an MRI or CT scan when appropriate. Several gross pathology photographs and an occasional EEG, evoked potential, and fundus photograph, are also included. There are also numerous helpful schematic diagrams.

There is room for improvement, as with all first edition books. It would be helpful to label the MRI and CT scans (I suspect many students cannot find the hippocampal atrophy without this), and the schematic diagrams could be drawn more realistically (i.e., with Wernicke’s and Broca’s areas drawn on an outline of a brain, not a straight-lined schematic). Definitions may be more appropriately …

Cases

In the following cases, common and rare diseases are represented with emphasis on localization and critical thinking. Each student is to work on them alone before class and hand in an answer. During class, an approach to the case and answer will be given.

Six cases from a larger pool will be used each 4 weeks. Reasonable answers to 5 of the 6 are needed to pass. Grades are Pass/Fail. Students are not limited to working through only six cases. Rather, students are encouraged to work through as many of the cases as they want, submit them online to the Clerkship Director, and feedback will be given.

The answers should include level of localization and why you think the Hx, PE and testing match a diagnosis or short differential.  Remember that your differential should include only diseases that are relevant for the level of localization.  For example, if you localize the problem to muscle, don't list multiple sclerosis (CNS disease) in the differential.  In no more than 1-2 sentences, list the next steps such as more testing or treatment.  I do not need to see all the information you learned about a particular disease or cut-paste from an online source.

One final thought. Work through the cases as you would in real life. Tests cost money and can have negative consequences. Although the computer won't limit you, don't just click on every level and all tests. Try to be practical and cost conscious.

Trouble shooting if the cases are blacked out from the start.  This problem does come up for a small number of students.
Ideas in order of most likely to help:
—Go to the case page —> right click on the case and open link in new window or tab.
—Some combination of computer and navigator, so switch those things up.  Firefox is good.
—You can try lowering the security for the case.
—Accept pop-ups.
—Try on a work computer.

Trouble shooting if you submit an answer and the page turns black or there is no confirmation phrase.  This means that the answer did not submit.  We are working on a fix.  Please email the answers to Dr. Kraus directly at This email address is being protected from spambots. You need JavaScript enabled to view it..

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