Neural

Question 1

WALLY

Answer 1

1. Firstly make note of any findings that :
   a. Drooling from the right side of his mouth
   b. Leaning to his right side
   c. Lack of strength on his right hand
   d. hypertension
2. why might you ask Ginny if wally stopped talking unexpectedly?
   a. He might have lost consciousness
3. What neurological problems are observable at presentation/ tha is what neural pathways and/or parts of the NS do you think have been damaged?
   a. As the right side of the body is affected the damamge can happen on left side of brain
   b. Motor neurons damage leads to contralateral hemiplegia (face and arm)
   c. Sensory neuron damage leads ot the loss of sensation on his arm and leg.
4. What particular disease best accounts for wallys presentation?
   a. Cerebral infarction- stroke
5. What do you think were the possible steps that lead to wally’s current disease?
   a. Smoking
   b. Hypertension
   c. Hyperlipidaemia
   d. Non compliant with medication (aspirin)→ fibrous plaque→ ulceration or rupture of plaque→ thrombus formed→ total vessel occulation
6. Looking at previous answers, are they any particular non neurological tests you think should be performed?
   a. A head CT would be done to rule out aneurism and haemorrhage
   b. Down the track 924-48 hrs) they would do an MRI to look for the extent of damage to brain tissue
7. Why would Wallys GP have suggested he take aspirin?
   a. To prevent blood clotting
8. What pharmacological interventions will wally require for the immediate treatment?
   a. Aspirin: even with history of gastric upset; within 48h of onset, alternative choice- clopidogrel (cost high)
   b. Thrombolytic therapy (if <3 hrs)
   c. May need warfarin for a short period

Question 2

JIM

Answer 2

1. what are the key clinical manifestations that raise concerns?
   a. Severe headache
   b. Nausea
   c. Left arm and leg weakness
   d. Drowsy
   e. Transient loss of consciousness
2. What is your preliminary diagnosis?
   a. Haemorrhagic stroke
3. Which tests can help to confirm your preliminary diagnosis?
   a. A head CT scan is efficient to distinguish most haemorrhage from ischemic stroke
4. What are the risk factors in this case?
   a. Hypertension
   b. Hyperlipidemia
   c. Smoking
   d. Regular intake of aspirin
   e. Old age
5. What measures need to be taken as early as possible?
   a. Correction of coagulopathies
   b. Managing elevated BP
   c. Involve neurosurgeon

Question 3

PARKKIINSONS

Answer 3

1. What is the typical age of onset of Parkinsons disease?
   Around 60
2. Describe the symptoms that can present in Parkinson’s disease:
   a. Tremor: cyclical movement of body part can represent physiologic process / manifestation of disease
   i. Intention or action tremor, a common manifestation of CEREBELLA DISEASES is aggravated by movement
   ii. In contrast resting tremor is maximal when there is no attempt at voluntary movement and occurs as relatively as a frequent manifestation of Parkinson disease.
   b. Bradykinesia: slow ability to start and continue movements and impaired ability to adjust the body’s position
   i. Can be symptom of neurological disorders, particularly parkinsons disease or side effect of medications
   c. Hypokinesia: refers to slow or diminished movement of body musculature
   d. Riidity: in medicine ( neurology) rigidity describes an increase in muscle tone, leading to a resistance to passive movement throughout the range of motion
3. Which group of nuclei are affected in the disease?
   a. The basal ganglia, substantia nigra
4. What is thought to be the underlying cause for most of the symptoms of parkinsons disease?
   a. Dopamine producing nerve cells of the substantia nigra, degenerate
5. What is the object of treatment of this disease?
   a. To increase dopaminergic activity while at the same time dampening down cholinergic activity
6. Why are injections of dopamine of no use in controlling Parkinsons disease?
   a. Because dopamine does not cross the BBB and dopamine exerts effects on the PNS eg. Increased HR
7. How is levodopa (L-dopa) thought to be effective in treating parkinsons disease?
   L- dopa crosses the BBB and is converted to dopamine in the brain

Question 4

HUNTINGTON CHOREA

Answer 4

1. what relevance has the age of onset huntingtons chorea to the passing on of the disease?
   a. The disease not manifest until about 40 yrs old by which time carriers of the gene for the disease would have had children and unsuspectingly passes on the gene to percentage of offspring
2. What are choreiform movements?
   Involuntary, forcible, rapid, jerky movements that may be subtle or become confident, markedly altering normal patterns of movement. Conditions which feature recurrent or persistent episodes of chorea as a primary manifestation of disease are referred to as choreatic disorders (chorea refers to brief repetitive jerky or dancelike uncontrolled movements caused by muscle contraction)
3. What is GABA?
   The major inhibitory neurotransmitter of nerve cells in the CNS