exam P2

Question 1

52. Disturbances of the Cerebrospinal Fluid Circulation. Hydrocephalus

Answer 1

Hydrocephalus is a condition characterized by an abnormal accumulation of cerebrospinal fluid (CSF) within the cavities (ventricles) of the brain. CSF is a clear, colorless fluid that surrounds the brain and spinal cord, providing cushioning and nutrition, as well as removing waste products.

Disturbances:

Overproduction: Rare, usually caused by choroid plexus papilloma.
Blocked Flow: Common causes include congenital malformations (e.g., aqueductal stenosis), tumors, cysts, or infections.
Impaired Absorption: Can result from conditions like meningitis or subarachnoid hemorrhage.

Hydrocephalus:

Types:
Communicating: CSF flows between ventricles but isn’t absorbed properly, often due to subarachnoid hemorrhage, meningitis, or congenital absence of arachnoid villi.
Non-communicating (Obstructive): Blockage prevents CSF from flowing through the ventricular system; common sites include the aqueduct of Sylvius and the foramen of Monro.
Symptoms:
Infants: Enlarged head, bulging fontanelle, irritability, poor feeding.
Adults/Older Children: Headache, nausea, vomiting, blurred vision, balance problems, cognitive difficulties.
Diagnosis:
Imaging: MRI, CT scan to visualize enlarged ventricles and identify blockages.
Other Tests: Lumbar puncture (with caution), CSF pressure monitoring.
Treatment:
Shunt Placement: Ventriculoperitoneal shunt to divert CSF from ventricles to the abdominal cavity.
Endoscopic Third Ventriculostomy (ETV): Creates an opening in the floor of the third ventricle to allow CSF to bypass obstruction.

Question 2

53. Idiopathic Facial Nerve Palsy (Bell Palsy)

Answer 2

-Definition: Sudden, unilateral facial muscle weakness or paralysis without a clear cause, presumed to be due to viral infection or inflammation of the facial nerve.
-Symptoms:
Sudden weakness or paralysis on one side of the face.
Drooping mouth, inability to close the eye, drooling.
Loss of taste on the anterior two-thirds of the tongue.
Hyperacusis (increased sensitivity to sound).
-Diagnosis:
Clinical Examination: Assessment of facial muscle strength and symmetry.
Exclusion of Other Causes: Imaging (MRI/CT) to rule out stroke, tumors, or infections; blood tests for Lyme disease, herpes zoster.
-Treatment:
Medications: Corticosteroids to reduce inflammation; antiviral drugs if a viral infection is suspected.
Eye Care: Artificial tears, eye patch to protect the cornea.
Physical Therapy: Exercises to improve facial muscle strength and coordination.

Question 3

54. Neurological Disorders Causing Hearing Loss: Ménière’s Disease

Answer 3

⦁ Definition: A chronic disorder of the inner ear characterized by episodes of vertigo, fluctuating hearing loss, tinnitus, and aural fullness.
⦁ Symptoms:
⦁ Vertigo: Episodes lasting minutes to hours, often associated with nausea and vomiting.
⦁ Hearing Loss: Sensorineural, fluctuating, and progressive, typically affecting one ear.
⦁ Tinnitus: Ringing or buzzing in the affected ear.
⦁ Aural Fullness: Sensation of pressure or fullness in the ear.
⦁ Diagnosis:
⦁ Clinical History: Recurrent episodes of vertigo with associated hearing loss.
⦁ Audiometry: Hearing tests to document sensorineural hearing loss.
⦁ Electrocochleography (ECoG): Measures electrical potentials in the inner ear.
⦁ MRI: To rule out other causes like vestibular schwannoma.
⦁ Treatment:
⦁ Lifestyle Modifications: Low-salt diet, avoidance of caffeine, alcohol, and tobacco.
⦁ Medications: Diuretics to reduce fluid buildup, antiemetics, vestibular suppressants (meclizine, diazepam), corticosteroids.
⦁ Surgical Options: Endolymphatic sac decompression, vestibular nerve section, labyrinthectomy in severe cases.

Question 4

55. Types of Vertigo

Answer 4

Peripheral Vertigo: Originates from the inner ear or vestibular nerve.
⦁
⦁ Examples:
⦁ Benign Paroxysmal Positional Vertigo (BPPV): Caused by dislodged otoliths in the semicircular canals.
⦁ Ménière’s Disease: Fluid imbalance in the inner ear.
⦁ Vestibular Neuritis: Inflammation of the vestibular nerve, often viral.
⦁ Labyrinthitis: Inflammation of the inner ear structures.
⦁ Symptoms: Sudden onset, severe spinning sensation, nausea, vomiting, balance issues, hearing loss (if labyrinthitis).
⦁ Diagnosis: Clinical examination, Dix-Hallpike maneuver for BPPV, audiometry, vestibular tests (e.g., caloric testing).
⦁ Treatment: Repositioning maneuvers (Epley for BPPV), medications (antihistamines, benzodiazepines, antiemetics), vestibular rehabilitation.
⦁
Central Vertigo: Originates from the brain or brainstem.
⦁
⦁ Examples:
⦁ Stroke: Particularly in the cerebellum or brainstem.
⦁ Multiple Sclerosis: Demyelinating lesions in the brain.
⦁ Migraine-Associated Vertigo: Vertigo associated with migraine headaches.
⦁ Tumors: Brainstem or cerebellar tumors.
⦁ Symptoms: Gradual onset, may be less severe but more persistent, often accompanied by other neurological symptoms (e.g., double vision, weakness).
⦁ Diagnosis: MRI or CT scan, neurological examination, vestibular tests.
⦁ Treatment: Treat underlying condition (e.g., antiplatelet therapy for stroke, disease-modifying therapies for MS, migraine prophylaxis).

Question 5

56. Peripheral Vestibular Lesions: Vestibular Neuropathy

Answer 5

⦁ Definition: Inflammation of the vestibular nerve, usually caused by a viral infection, leading to sudden onset of vertigo.
⦁ Symptoms:
⦁ Sudden, severe vertigo.
⦁ Nausea, vomiting.
⦁ Imbalance, difficulty walking.
⦁ No hearing loss (distinguishes from labyrinthitis).
⦁ Diagnosis:
⦁ Clinical History: Sudden onset vertigo without hearing loss.
⦁ Vestibular Testing: Caloric test showing unilateral hypofunction, head impulse test.
⦁ Exclusion of Other Causes: MRI to rule out central causes.
⦁ Treatment:
⦁ Medications: Vestibular suppressants (meclizine, diazepam) for acute symptoms, corticosteroids.
⦁ Antiviral Therapy: If a viral etiology is strongly suspected.
⦁ Vestibular Rehabilitation: Exercises to improve balance and compensate for vestibular loss.

Question 6

57. Peripheral Vestibular Lesions: Benign Paroxysmal Positional Vertigo (BPPV)

Answer 6

⦁ Definition: A common cause of vertigo resulting from dislodged otoliths (calcium carbonate crystals) within the semicircular canals of the inner ear.
⦁ Symptoms:
⦁ Brief episodes of vertigo, typically lasting less than a minute.
⦁ Triggered by specific head movements (e.g., rolling over in bed, looking up).
⦁ Nausea, sometimes vomiting.
⦁ Diagnosis:
⦁ Dix-Hallpike Maneuver: Elicits vertigo and characteristic nystagmus.
⦁ Other Positional Tests: Supine roll test for horizontal canal BPPV.
⦁ Treatment:
⦁ Repositioning Maneuvers: Epley maneuver (for posterior canal BPPV), Semont maneuver, Brandt-Daroff exercises.
⦁ Medications: Vestibular suppressants for acute episodes, not recommended long-term.

Question 7

58. Peripheral Vestibular Lesions: Acoustic Neuroma

Answer 7

⦁ Definition: A benign tumor arising from the Schwann cells of the vestibulocochlear nerve (cranial nerve VIII), also known as vestibular schwannoma.
⦁ Symptoms:
⦁ Progressive, unilateral sensorineural hearing loss.
⦁ Tinnitus (ringing in the ear).
⦁ Balance disturbances.
⦁ Facial numbness or weakness (if tumor compresses facial nerve).
⦁ Diagnosis:
⦁ Audiometry: To assess hearing loss.
⦁ MRI with Contrast: To visualize the tumor.
⦁ Brainstem Auditory Evoked Potentials (BAEPs): To evaluate nerve function.
⦁ Treatment:
⦁ Observation: Small, asymptomatic tumors.
⦁ Surgery: Microsurgical removal, especially for larger tumors.
⦁ Radiotherapy: Stereotactic radiosurgery (e.g., Gamma Knife) for medium-sized tumors.

Question 8

59. Glossopharyngeal Neuralgia

Answer 8

⦁ Definition: A rare condition characterized by severe, episodic pain in the areas innervated by the glossopharyngeal nerve (throat, tongue, ear).
⦁ Symptoms:
⦁ Sudden, sharp, stabbing pain lasting seconds to minutes.
⦁ Triggered by swallowing, chewing, talking, coughing, or yawning.
⦁ Pain typically affects one side.
⦁ Diagnosis:
⦁ Clinical History: Description of characteristic pain and triggers.
⦁ Exclusion of Other Causes: MRI or CT scan to rule out tumors, vascular anomalies.
⦁ Treatment:
⦁ Medications: Anticonvulsants (carbamazepine, gabapentin), antidepressants (amitriptyline).
⦁ Nerve Blocks: Local anesthetics or steroids.
⦁ Surgery: Microvascular decompression, radiofrequency ablation, or nerve sectioning in refractory cases.

Question 9

60. Headache and Facial Pain: Classification, Red Flags, Treatment

Answer 9

⦁ Classification:
⦁ Primary Headaches:
⦁ Migraine: Pulsatile, often unilateral, associated with nausea, photophobia, phonophobia, and sometimes aura.
⦁ Tension-Type Headache: Bilateral, non-pulsatile, pressure or tightness, mild to moderate intensity.
⦁ Cluster Headache: Severe, unilateral, periorbital pain, associated with autonomic symptoms (tearing, nasal congestion).
⦁ Secondary Headaches: Caused by an underlying condition (e.g., infection, tumor, vascular disorder, trauma).
⦁ Red Flags(“SNOOP”):
⦁ S: Systemic symptoms (fever, weight loss) or secondary risk factors (HIV, cancer).
⦁ N: Neurological symptoms (confusion, weakness, vision changes).
⦁ O: Onset (sudden, “thunderclap” headache).
⦁ O: Older age (>50 years) at onset.
⦁ P: Previous headache history (new or different headache).
⦁ Treatment:
⦁ Primary Headaches:
⦁ Migraine: Acute (triptans, NSAIDs), preventive (beta-blockers, antiepileptics, CGRP inhibitors).
⦁ Tension-Type: NSAIDs, muscle relaxants, stress management, physical therapy.
⦁ Cluster: Acute (oxygen, sumatriptan), preventive (verapamil, corticosteroids).
⦁ Secondary Headaches: Treat underlying cause (e.g., antibiotics for infection, surgery for tumors).

Question 10

61. Involuntary Movements: Types of Dyskinesias

Answer 10

⦁ Types:
⦁ Tremor: Rhythmic, oscillatory movements (e.g., Parkinson’s disease, essential tremor).
⦁ Chorea: Irregular, dance-like movements (e.g., Huntington’s disease, Sydenham’s chorea).
⦁ Athetosis: Slow, writhing movements (e.g., cerebral palsy).
⦁ Dystonia: Sustained muscle contractions causing twisting and repetitive movements (e.g., cervical dystonia, writer’s cramp).
⦁ Myoclonus: Sudden, brief, shock-like contractions (e.g., myoclonic epilepsy, Creutzfeldt-Jakob disease).
⦁ Tics: Sudden, repetitive movements or sounds (e.g., Tourette’s syndrome).
⦁ Diagnosis and Treatment:
⦁ Clinical Examination: Observation of movement patterns, neurological examination.
⦁ Imaging and Laboratory Tests: MRI, genetic testing, blood tests to identify underlying causes.
⦁ Medications: Dopamine antagonists for tics, anticonvulsants for myoclonus, botulinum toxin for dystonia.
⦁ Physical and Occupational Therapy: To improve function and manage symptoms.

Question 11

62. Acute Stroke: Symptoms of Ischemic Stroke, The National Institutes of Health Stroke Scale (NIHSS)

Answer 11

⦁ Symptoms of Ischemic Stroke:
⦁ Sudden numbness or weakness, especially on one side of the body.
⦁ Sudden confusion, trouble speaking, or understanding speech.
⦁ Sudden trouble seeing in one or both eyes.
⦁ Sudden trouble walking, dizziness, loss of balance or coordination.
⦁ Sudden severe headache with no known cause.
⦁ NIHSS:
⦁ Purpose: Quantify the severity of stroke-related neurological deficits.
⦁ Components: Level of consciousness, gaze, visual fields, facial palsy, motor arm and leg function, limb ataxia, sensory loss, language, speech, and extinction/inattention.
⦁ Scoring: Higher scores indicate greater severity of deficits, used to guide treatment decisions and predict outcomes.

Question 12

63. Acute Stroke: Risk Factors, Diagnosis, Treatment

Answer 12

⦁ Risk Factors:
⦁ Modifiable: Hypertension, diabetes, smoking, hyperlipidemia, atrial fibrillation, obesity, physical inactivity, excessive alcohol use.
⦁ Non-Modifiable: Age, gender (higher in men), race (higher in African Americans), family history, prior stroke or TIA.
⦁ Diagnosis:
⦁ Clinical Examination: Assessment of neurological deficits.
⦁ Imaging:
⦁ CT Scan: Initial imaging to rule out hemorrhage.
⦁ MRI: Detailed imaging to identify ischemic areas.
⦁ Other Tests: Carotid ultrasound, echocardiogram, blood tests (glucose, coagulation profile).
⦁ Treatment:
⦁ Ischemic Stroke:
⦁ Acute: Thrombolytics (e.g., tPA within 4.5 hours of onset), mechanical thrombectomy (for large vessel occlusions).
⦁ Secondary Prevention: Antiplatelet agents (aspirin, clopidogrel), anticoagulants (for atrial fibrillation), statins, blood pressure control, lifestyle modifications.
⦁ Hemorrhagic Stroke:

Question 13

64. Acute Stroke: Symptoms of Intracerebral Hemorrhage

Answer 13

⦁ Symptoms:
⦁ Sudden severe headache.
⦁ Nausea and vomiting.
⦁ Sudden loss of consciousness or decreased level of consciousness.
⦁ Neurological deficits (similar to ischemic stroke): Weakness, numbness, difficulty speaking, vision changes.
⦁ Seizures (in some cases).
⦁ Diagnosis:
⦁ CT Scan: Quickly identifies bleeding and its location.
⦁ MRI: Provides detailed images, especially for smaller or more complex hemorrhages.
⦁ Angiography: To identify underlying vascular abnormalities (e.g., aneurysms, arteriovenous malformations).

Question 14

65. Subarachnoid Hemorrhage. The Hunt-Hess Scale for Aneurysmal Subarachnoid Hemorrhage

Answer 14

⦁ Definition: Bleeding into the subarachnoid space, often due to ruptured aneurysm.
⦁ Symptoms:
⦁ Sudden, severe headache (“thunderclap headache”).
⦁ Nausea and vomiting.
⦁ Stiff neck.
⦁ Loss of consciousness.
⦁ Focal neurological deficits.
⦁ Hunt-Hess Scale:
⦁ Grade I: Asymptomatic or mild headache, slight nuchal rigidity.
⦁ Grade II: Moderate to severe headache, nuchal rigidity, no neurological deficit other than cranial nerve palsy.
⦁ Grade III: Drowsiness, confusion, mild focal neurological deficit.
⦁ Grade IV: Stupor, moderate to severe hemiparesis.
⦁ Grade V: Coma, decerebrate posturing.

Question 15

66. Subarachnoid Hemorrhage: Diagnosis, Treatment

Answer 15

⦁ Diagnosis:
⦁ Clinical Examination: Sudden severe headache, neurological deficits.
⦁ Imaging:
⦁ CT Scan: Initial imaging to detect subarachnoid blood.
⦁ Lumbar Puncture: If CT is negative but clinical suspicion remains high, to detect blood or xanthochromia in CSF.
⦁ Angiography: To identify and locate aneurysm or other vascular abnormalities.
⦁ Treatment:
⦁ Initial Management: Stabilization, blood pressure control, pain management, antiemetics.
⦁ Surgical:
⦁ Aneurysm Clipping: Surgical clipping of the aneurysm to prevent rebleeding.
⦁ Endovascular Coiling: Minimally invasive procedure to occlude the aneurysm.
⦁ Supportive Care: Intensive monitoring, prevention of complications (e.g., vasospasm, hydrocephalus), rehabilitation.

Question 16

67. Traumatic Brain Injury (TBI): Subdural and Epidural Hematoma. Differential Diagnosis, Diagnosis, Treatment

Answer 16

⦁ Definitions:
⦁ Subdural Hematoma: Blood collection between the dura and arachnoid mater, often due to tearing of bridging veins.
⦁ Epidural Hematoma: Blood collection between the dura mater and the skull, typically caused by arterial bleeding (e.g., middle meningeal artery) following a skull fracture.
⦁ Symptoms:
⦁ Subdural Hematoma: Gradual onset of headache, confusion, drowsiness, weakness, seizures.
⦁ Epidural Hematoma: Loss of consciousness followed by a lucid interval, then rapid deterioration (headache, vomiting, confusion, hemiparesis).
⦁ Diagnosis:
⦁ Imaging: CT scan to visualize hematoma and assess severity.
⦁ Differential Diagnosis: Rule out other causes of altered mental status or focal neurological deficits (e.g., stroke, encephalitis).
⦁ Treatment:
⦁ Subdural Hematoma:
⦁ Small/Chronic: Observation, repeat imaging, medical management.
⦁ Large/Acute: Surgical evacuation (burr hole, craniotomy).
⦁ Epidural Hematoma:
⦁ Small/Stable: Observation, serial imaging.
⦁ Large/Rapidly Expanding: Emergency craniotomy and hematoma evacuation.

Question 17

68. Arteriovenous Vascular Malformations: Clinical Features, Diagnosis, Treatment

Answer 17

⦁ Definition: Abnormal tangle of blood vessels connecting arteries and veins, bypassing capillary beds, prone to bleeding.
⦁ Clinical Features:
⦁ Seizures.
⦁ Headache.
⦁ Focal neurological deficits.
⦁ Intracranial hemorrhage (sudden onset of severe symptoms).
⦁ Diagnosis:
⦁ Imaging:
⦁ MRI/MRA: Detailed visualization of vascular malformation.
⦁ CT Scan: To detect bleeding.
⦁ Angiography: Gold standard for detailed assessment of AVM architecture.
⦁ Treatment:
⦁ Observation: For small, asymptomatic AVMs.
⦁ Surgical Resection: For accessible AVMs with a high risk of bleeding.
⦁ Endovascular Embolization: Minimally invasive procedure to reduce blood flow to the AVM.
⦁ Radiosurgery: Focused radiation to induce gradual obliteration of the AVM.

Question 18

69. Speech Disorders: Types of Aphasia

Answer 18

⦁ Types:
⦁ Broca’s Aphasia: Non-fluent, expressive aphasia. Patients have difficulty speaking and writing but understand spoken and written language relatively well.
⦁ Wernicke’s Aphasia: Fluent, receptive aphasia. Patients speak in long sentences that have no meaning, add unnecessary words, and create new words. They have severe comprehension difficulties.
⦁ Global Aphasia: Severe form involving both expressive and receptive difficulties. Patients can neither speak nor understand spoken language.
⦁ Conduction Aphasia: Fluent speech with good comprehension but poor repetition and frequent errors in word choice.
⦁ Anomic Aphasia: Difficulty in naming objects and finding words, with relatively preserved speech and comprehension.
⦁ Diagnosis:
⦁ Clinical Evaluation: Speech and language assessment by a speech-language pathologist.
⦁ Imaging: MRI or CT scan to identify brain lesions causing aphasia.
⦁ Treatment:
⦁ Speech and Language Therapy: Tailored exercises to improve communication skills.
⦁ Supportive Communication Strategies: Using alternative communication methods, family education.
⦁ Medication: Potential use of medications to enhance language recovery (research ongoing).

Question 19

70. Coma: Glasgow Coma Scale, Diagnostic Tests, Treatment

Answer 19

⦁ Glasgow Coma Scale (GCS):
⦁ Components:
⦁ Eye Opening(4 points): Spontaneous, to speech, to pain, none.
⦁ Verbal Response(5 points): Oriented, confused, inappropriate words, incomprehensible sounds, none.
⦁ Motor Response(6 points): Obeys commands, localizes pain, withdraws from pain, flexion (decorticate), extension (decerebrate), none.
⦁ Scoring: Total score ranges from 3 to 15; lower scores indicate deeper levels of coma.
⦁ Diagnostic Tests:
⦁ Initial Assessment: ABCs (airway, breathing, circulation), GCS.
⦁ Imaging: CT scan, MRI to identify structural causes (e.g., hemorrhage, stroke, tumor).
⦁ Laboratory Tests: Blood tests (glucose, electrolytes, liver and kidney function, toxicology screen), lumbar puncture (if infection suspected).
⦁ EEG: To assess for seizure activity.
⦁ Treatment:
⦁ Stabilization: Airway management, ventilation, circulatory support.
⦁ Treat Underlying Cause: Addressing infections, controlling seizures, managing intracranial pressure (ICP).
⦁ Supportive Care: Preventing complications (e.g., pressure sores, infections), nutritional support, rehabilitation.

Question 20

71. Parkinson Disease: Clinical Features, Diagnosis, Treatment

Answer 20

⦁ Clinical Features:
⦁ Resting tremor (pill-rolling tremor).
⦁ Bradykinesia (slowness of movement).
⦁ Rigidity (muscle stiffness).
⦁ Postural instability (balance problems).
⦁ Other Symptoms: Mask-like facial expression, shuffling gait, micrographia, non-motor symptoms (depression, sleep disturbances, cognitive impairment).
⦁ Diagnosis:
⦁ Clinical Examination: Based on cardinal motor symptoms.
⦁ Response to Dopaminergic Medication: Improvement with levodopa confirms diagnosis.
⦁ Imaging: DaTscan (dopamine transporter scan) to support diagnosis.
⦁ Treatment:
⦁ Medications:
⦁ Levodopa/Carbidopa: Mainstay of treatment.
⦁ Dopamine Agonists: Ropinirole, pramipexole.
⦁ MAO-B Inhibitors: Selegiline, rasagiline.
⦁ COMT Inhibitors: Entacapone, tolcapone.
⦁ Surgical: Deep brain stimulation (DBS) for advanced cases.
⦁ Supportive Therapies: Physical therapy, occupational therapy, speech therapy.

Question 21

72. Multiple Sclerosis: Clinical Features, Diagnosis, Treatment

Answer 21

⦁ Clinical Features:
⦁ Relapsing-Remitting MS (most common): Episodes of neurological dysfunction followed by periods of remission.
⦁ Symptoms: Optic neuritis, motor weakness, sensory disturbances, ataxia, spasticity, bladder/bowel dysfunction, cognitive impairment.
⦁ Diagnosis:
⦁ Clinical History and Examination: Based on relapses and remissions of neurological symptoms.
⦁ MRI: Lesions in the brain and spinal cord.
⦁ Lumbar Puncture: Oligoclonal bands in CSF.
⦁ Evoked Potentials: Slowed conduction in visual or somatosensory pathways.
⦁ Treatment:
⦁ Acute Relapses: Corticosteroids (methylprednisolone).
⦁ Disease-Modifying Therapies: Interferons, glatiramer acetate, natalizumab, fingolimod, ocrelizumab.
⦁ Symptomatic Treatment: Medications for spasticity, pain, fatigue, bladder dysfunction.

Question 22

73. Cerebral Sinus Thrombosis: Clinical Features, Diagnosis, Treatment

Answer 22

⦁ Clinical Features:
⦁ Headache (often severe).
⦁ Visual disturbances.
⦁ Seizures.
⦁ Focal neurological deficits (e.g., weakness, numbness).
⦁ Altered mental status.
⦁ Diagnosis:
⦁ Imaging:
⦁ MRI/MRV: Magnetic resonance venography to visualize thrombosis.
⦁ CT/CTV: Computed tomography venography.
⦁ Laboratory Tests: Coagulation profile, tests for thrombophilia, infection markers.
⦁ Treatment:
⦁ Anticoagulation: Heparin, followed by oral anticoagulants (warfarin).
⦁ Thrombolysis: In selected severe cases.
⦁ Management of Intracranial Hypertension: Measures to reduce intracranial pressure.
⦁ Treatment of Underlying Conditions: Infections, hypercoagulable states.

Question 23

74. Myasthenia Gravis: Clinical Features, Diagnosis, Treatment

Answer 23

⦁ Clinical Features:
⦁ Fluctuating muscle weakness, worsening with activity.
⦁ Ptosis (drooping eyelids), diplopia (double vision).
⦁ Bulbar symptoms: Dysphagia (difficulty swallowing), dysarthria (difficulty speaking).
⦁ Generalized weakness affecting limbs.
⦁ Diagnosis:
⦁ Clinical Examination: Fatigability of muscles, ice pack test for ptosis.
⦁ Antibody Tests: Acetylcholine receptor antibodies, MuSK antibodies.
⦁ Electrophysiology: Repetitive nerve stimulation, single-fiber EMG.
⦁ Imaging: Chest CT to detect thymoma.
⦁ Treatment:
⦁ Acetylcholinesterase Inhibitors: Pyridostigmine.
⦁ Immunosuppressive Therapy: Corticosteroids, azathioprine, mycophenolate mofetil.
⦁ Thymectomy: Surgical removal of thymus gland.
⦁ Plasmapheresis/IVIG: For myasthenic crisis or severe exacerbations.

Question 24

75. Brain Tumors: Clinical Features, Diagnosis, Treatment

Answer 24

⦁ Clinical Features:
⦁ Headache, often worse in the morning.
⦁ Seizures.
⦁ Focal neurological deficits (e.g., weakness, sensory changes).
⦁ Cognitive or personality changes.
⦁ Nausea and vomiting.
⦁ Diagnosis:
⦁ Imaging: MRI with contrast, CT scan.
⦁ Biopsy: Histopathological examination to determine tumor type.
⦁ Additional Tests: Functional MRI, PET scan for metabolic activity.
⦁ Treatment:
⦁ Surgery: Resection of the tumor.
⦁ Radiation Therapy: External beam radiation, stereotactic radiosurgery.
⦁ Chemotherapy: Temozolomide, other agents depending on tumor type

Answer 25

Infectious diseases affecting the Central Nervous System (CNS) can have severe implications and must be diagnosed and treated promptly. Here’s an overview covering the classification, clinical features, diagnosis, and treatment of infectious diseases of the CNS:

Classification of Infectious Diseases of the CNS:

1. Bacterial Infections:
   
   • Examples include bacterial meningitis, brain abscess, and bacterial encephalitis.
2. Viral Infections:
   
   • Viral meningitis, viral encephalitis, and infections by viruses like herpes simplex virus (HSV) or varicella-zoster virus (VZV).
3. Fungal Infections:
   
   • Fungal meningitis, such as cryptococcal meningitis, and other fungal CNS infections.
4. Parasitic Infections:
   
   • Parasitic infections like cerebral malaria, toxoplasmosis, and neurocysticercosis.
5. Prion Diseases:
   
   • Rare CNS disorders caused by abnormal prion proteins, like Creutzfeldt-Jakob disease.

Clinical Features of Infectious Diseases of the CNS:

1. Meningitis:
   
   • Symptoms can include fever, headache, neck stiffness, photophobia, altered mental status, and in severe cases, seizures.
2. Encephalitis:
   
   • Symptoms may include fever, headache, altered consciousness, focal neurological deficits, seizures, and behavioral changes.
3. Brain Abscess:
   
   • Clinical features include persistent headache, focal neurological deficits, fever, nausea, and vomiting.
4. Specific Infections:
   
   • Different infectious agents may present with specific clinical features, such as rash in viral infections or focal brain lesions in parasitic infections.

Diagnosis and Treatment:

1. Diagnosis:
   
   • Diagnosis involves a combination of clinical evaluation, imaging studies (CT scan or MRI), cerebrospinal fluid analysis (lumbar puncture), and specific laboratory tests (serology, PCR, culture).
2. Treatment:
   
   • Treatment varies depending on the causative agent
3. Antibiotics:
   
   • Antibiotics are used to treat bacterial infections of the CNS, such as bacterial meningitis and brain abscesses. Common antibiotics include:
     
     • Ceftriaxone: Effective against a broad spectrum of bacteria and commonly used in treating meningitis.
     • Vancomycin: Used for resistant bacterial infections, including methicillin-resistant Staphylococcus aureus (MRSA).
4. Antiviral Medications:
   
   • Antiviral drugs are used to treat viral infections of the CNS, including viral meningitis and encephalitis. Examples include:
     
     • Acyclovir: Effective against herpes simplex virus (HSV) and varicella-zoster virus (VZV) infections.
     • Ganciclovir: Used for cytomegalovirus (CMV) infections and certain other viral infections.
5. Antifungal Agents:
   
   • Antifungal medications are used to treat fungal infections of the CNS, such as fungal meningitis. Common antifungal drugs include:
     
     • Amphotericin B: Effective against a broad range of fungal infections but can have significant side effects.
     • Fluconazole: Used for certain types of fungal infections with good CNS penetration.
6. Antiparasitic Medications:
   
   • Parasitic infections of the CNS, like neurocysticercosis or cerebral malaria, may require specific antiparasitic drugs, such as:
     
     • Praziquantel: Used to treat parasitic infections like neurocysticercosis.
     • Chloroquine: Anti-malarial medication used for treating cerebral malaria.
7. Steroids:
   
   • Steroids may be prescribed to reduce inflammation and swelling in the CNS during infections like meningitis or encephalitis. Examples include:
     
     • Dexamethasone: Often used as an adjunctive therapy in bacterial meningitis to reduce inflammation.
8. Antiretroviral Therapy (ART):
   
   • For infections involving the human immunodeficiency virus (HIV) that can affect the CNS, antiretroviral medications are used to suppress viral replication and manage the infection.
9. Supportive Care:
   
   • Supportive care to manage symptoms and complications, such as fever control, hydration, and anti-seizure medications.