21 November

Question 1

What is the acute management of migraine?

Answer 1

Triptan with either NSAID or paracetamol
People aged 12-17 consider nasal triptan first

Question 2

What is prophylactic management of migraine?

Answer 2

If impacting on life and daily function with frequent occurrence

Propranolol
Topiramate- teratogenic
Amitriptyline

Question 3

What is the management of Parkinsons disease?

Answer 3

First line levodopa if motor symptoms
If ongoing symptoms or dyskniesia development then add either dopamine agonist e.g. pramipexole, ropinirole, MOA-B inhibitors e.g. rasagiline or COMT inhibitors e.g. entacaponeW

Question 4

What are features of abducens nerve lesion?

Answer 4

Lesion will be same side as affected nerve
Double vision when abducting eye- horizontal double vision
Weak/inability to abduct eye- double vision worsened on abduction
Convergent squint aka in rested position, eye faces towards nose

Question 5

What are signs of a complete oculomotor nerve lesion?

Answer 5

Lesion will be same side as affected nerve
Down and out position of eye
Ptosis
Mydriasis (dilated pupil)
Non reacting to light

Question 6

What are the features of trochlear nerve lesion?

Answer 6

Commonly caused by head trauma
Vertical torsional double vision (images on top of each other)
Double vision worse on downward gaze e.g. walking downstairs and gaze away from affected side
e.g. if left side affected double vision worse on looking to the right and vice versa

Question 7

What are features of Wernicke’s encephalopathy?

Answer 7

Oculomotor dysfunction- nystagmus, lateral rectus palsy
Gait ataxia
Confusion
Disorientation
Inattentiveness
Peripheral sensory neuropathy

Question 8

What are features of a middle cerebral artery stroke?

Answer 8

Contralateral hemiparesis and sensory loss upper extremity >lower
Contralateral homonymous hemianopia
Aphasia

Question 9

What are features of Anterior cerebral artery stroke?

Answer 9

Contralateral hemiparesis and sensory loss
Lower extremeity>upper

Question 10

What are features of posterior cerebral artery stroke?

Answer 10

Contralateral homonymous hemianopia with macular sparing
Visual agnosia (can see cat in room but can’t tell you cat by looking at it)

Question 11

What are features of basilar artery stroke?

Answer 11

Locked in syndrome

Question 12

What are features of retinal/ophthalmic artery stroke?

Answer 12

Amaurosis fugax

Question 13

What are features of anterior inferior cerebellar artery stroke?

Answer 13

Ipsilateral facial paralysis and deafness
Features of Wallenbergs syndrome

Question 14

What are features of posterior inferior cerebellar artery stroke?

Answer 14

Wallenberg syndrome- ataxia, nystagmus
Ipsilateral facial pain and temp loss
Contralateral limb/troso pain and temp loss

Question 15

What are features of Weber syndrome (stroke in posterior cerebral artery that supply midbrain)_

Answer 15

Ipsilateral CNIII nerve palsy
Contralateral weakness of upper and lower extremities

Question 16

What should sodium valproate be switched to in women wanting to conceive?

Answer 16

Lamotrigine or keppra

Question 17

When can anti-epileptic medication be stopped?

Answer 17

If someone is seizure free for more than 2 years

Question 18

What are side effects of sodium valproate?

Answer 18

Teratogenic
Increased appetite and weight gain
Alopecia
Tremor
Nausea
Hepatotoxicity
Pancreatitis
Hyponatraemia

Question 19

What are symptoms of acoustic neuroma?

Answer 19

Unilateral or asymmetrical hearing loss or tinnitus
Impaired facial sensation
Unexplained balance problems

Other symptoms are based on where the mass compresses

Question 20

What are features of myasthenia gravis?

Answer 20

Fatiguable symptoms- slurring of speech/drooping eyelids in the evening

Question 21

What are features of guillain-Barre Syndrome?

Answer 21

Post viral polyneuropathy
Initial malaise, weakness/tingling in the legs
Followed by rapid progressive ascending paralysis
Can involve resp muscles in severe questions

Question 22

What are features of MS?

Answer 22

Optic neuritis- common prodromal
Followed by relapses of sensory/motor or cerebellar symptoms

Question 23

What are sensory features of MS?

Answer 23

Pins/needles
numbness
Trigeminal neuralgia

Question 24

What are motor features of MS?

Answer 24

Spastic weakness- commonly in the legs

Question 25

What are cerebellar features of MS?

Answer 25

Ataxia-common seen in acute relapse
tremor

Question 26

What are features of radial nerve palsy?

Answer 26

Wrist drop
Sensory loss in dorsal aspect of hand

Question 27

What is Horners syndrome?

Answer 27

Can occur due to pancoast tumour
Combination of ptosis, miosis, enopthalmos and anhydrosis

Question 28

What is Wests syndrome?

Answer 28

Infantile spasm
Drawing up of knees, shock flexion of arms, head and neck
Progressive learning difficulties and EEG changes

Question 29

What are causes of Wests syndrome?

Answer 29

Perinatal asphyxia
Encephalitis
Metabolic disorders
Cerebral malformations

Question 30

What is Janz syndrome?

Answer 30

Juvenile myoclonic epilepsy
Triad of infrequent generalised seizures (often on waking), daytime absences and sudden myoclonus normally in the morning

Treatment with valproate

Question 31

What are features of motor neuron disease?

Answer 31

Asymmetrical limb weakness
Lower and upper motor neuron signs
Wasting of small hand muscles
Fasiculations
Absence of sensory symptoms or signs

No cerebellar signs
No ocular muscle involvement

Question 32

What are symptoms of friedrichs ataxia?

Answer 32

Difficulty walking or standing
Involuntary jerky movements
Fatigue
Slurred speech
Difficulty swallowing
Vision loss
Hearing loss
Scoliosis
Loss of sensation from legs upwards
Heart conditions- cardiomyopathy

Question 33

What are symptoms of subdural haemorrhage?

Answer 33

Altered mental status
Neurological deficits- visual field defects, aphasia, weakness
Headache
Seizures