The essay is a case report of a neurological patient seen during the module or in your own clinical practice (with the prior agreement of Dr ???. The essay should
demonstrate an understanding of how the history and examination findings are used, first, in localisation of brain lesions and, second, in generating hypotheses that
can be used to guide neuropsychological assessment.
The case report should include:
I. Clinical presentation:
Relevant history (presenting symptoms, onset/progression, associated medical conditions relevant to the current problem).
Neurological examination findings: e.g., motor (strength, coordination, reflexes), somatosensory, visual, eye movements, etc…
Cognitive examination findings.
In some cases, there will be limited or no information in some of the above sections.
Guidance Note: A well written case report should not simply state your interpretation of the findings, but paint a vivid picture of what you observed. For example, if
you are describing an aphasic patient who has anomia, you will not only want to say whether the patient makes semantic or phonemic paraphasic errors, but also give
some examples. Similarly, it is not adequate to say that the patient ‘had apraxia’. Describe how it was tested for and what was observed.
Ideally, you should base this section on what you observed during the examination, from your notes. The key objective here is to demonstrate your knowledge and
understanding of key facts and principles.
II. Analysis of the Case
This should consider:
Based on the history and examination, what is the most likely diagnosis? If the diagnosis is not obvious, what is the differential diagnosis (what aetiologies are to
How each finding on the neurological and mental status examinations is used to infer possible lesion localisation(s).
Guidance Note: In discussing localisation, you will want to demonstrate a solid grasp of functional neuroanatomy. For example, if a patient is weak and has increased
reflexes on one side of the body, you can conclude that there is damage somewhere in either the primary motor cortex or the cortico-spinal tract. A bald statement to
this effect, however, only demonstrates that you have memorised this as a fact – not that you know anything about the origin of the cortico-spinal tract or its
anatomy. An optimal treatment would discuss this anatomy and where in the brain the lesion could be located.
Discuss the case with reference to literature on the patient’s neurological and neuropsychological deficits. If a patient has multiple problems (e.g., visual agnosia
and Balint’s syndrome), you may chose to concentrate on one. Suggest a research question that could be addressed using the patient as a participant.
• case report of a neurological patient.
• patient may be one seen during the module OR
• on the wards or in your own clinical experience; if so, please discuss with Dr Bracewell before preparing your essay to ensure the case is suitable.
Purpose of Case Report
• To demonstrate an understanding of how examination findings from the neurological and, if relevant, mental status examinations are used:
• in localisation of brain lesions
• in generating hypotheses that can be used to guide neurological and neuropsychological assessment.
• Clinical history
• Clinical examination
• Analysis of case
• Discussion of case
• Possible research question
• presenting symptoms
• associated medical conditions relevant to the current problem
• General neurological signs
• Cognitive/behavioural assessment
• Imaging (CT, MRI)
• Other investigations
Analysis of case
• Localisation (where is the lesion?)
• Aetiology (what caused the lesion?)
• Explain how you made your inferences based on the history and examination
• What does the imaging show?
Discussion of case
• Discuss the case with reference to literature on the patient’s neurological and neuropsychological deficit(s).
• Suggest a research question that could be addressed using the patient as a participant
• When you were thinking about the patient and the literature, what intrigued you?
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