Neuro

Question 1

Classic features of NMO

Answer 1

Severe bilateral Optic neuritis and myelitis:
Loss of vision
Periocular pain
Dyschromatopsia

Question 2

Disease associations with NMO

Answer 2

Sjogrens, SLE, Crohns, sarcoid

Question 3

NMO vs MS

Answer 3

NMO = spinal cord and optic nerves
MS = sc, on AND brain

Question 4

Imaging features of NMO on MRI spine

Answer 4

Longitudinally extension central lesions of >3 vertebral segments

Question 5

Duration of MS symptoms to be considered an attack

Answer 5

At least 24 hours
With or without recovery, in absence of fever

Question 6

Spinal cord lesion
Multifocal causes
Large segment causes

Answer 6

Multifocal causes: neoplastic, paraneoplastic,
Large segment causes:

Question 7

Signs of MS on MRI (new Mcdonald criteria 2024)

Answer 7

1. CVS - central vein sign - presence for a blood vessel through middle of an MS lesion
2. PRLs - paramagnetic ring lesions - ring of iron around edge of active MS lesion
3. Kappa free light chains in CSF (as accurate as oligoclonal band)

Question 8

Dorsal column of spinal cord issue most likely to be caused by

Answer 8

Metabolic issue eg vitamin def such as b12 def

Question 9

Alpha synucleinopathies

Answer 9

PD, LBD, MSA

Question 10

Tau diseases

Answer 10

FTL

Question 11

Alemtuzumab 12 monthly for 2 (or 3 doses), what % of people develop AI disease and what is AI D is most common?

Answer 11

30%, thyroiditis
1% of glomerulonephritis, eg similar to good pastures disease (can be very bad, worse than normal GP D)

Question 12

MS treatments (mabs) and MOA

Answer 12

Natalizumab, monthly IV. A4 Integrin on T cells, prevents crossing BBB

Ocrelizumab - CD20 on b cells. Kills all middle aged b cells (not precursor or mature) 6 monthly IV
Issue with hypogammaglobulinaemia

Alemtuzumab - hard rest of Immune system. T and B cells CD52. 12 monthly, 5 days in a row, then next year 3 days in a row.

Question 14

A virus that causes a cauda equina/conus medullaris picture

Answer 14

HSV2

Question 15

Poliomyelitis affects which area of the spinal cord

Answer 15

Anterior segment

Question 16

Presentation of West Nile Virus myelopathy

Answer 16

Subacute, months, progressive anterior cord syndrome, with high high fevers
But can be acute flavid paralysis
WNV can also cause encephalitis and meningitis

Question 18

Mix of UMN and LMN sx, involving anterior horns

Answer 18

MND

Question 20

What is MELAS?

Answer 20

Mitochondrial myopathy, encephalopathy, lactic acidosis and stroke syndrome (MELAS)
Maternally inherited