Neuro

Question 1

causes of unilateral visual loss

Answer 1

• vascular (amaurosis fugax, CRVO, anterior ischaemic optic neuropathy)
• optic neuritis
• retinal detachment

Question 2

Optic neuropathy causes

Answer 2

• inflammatory (optic neuritis)
  
  • demyelination associated with MS
• vascular (ischaemic optic neuropathy)
• space occupying lesion
• toxins/drugs (alcohol, methanol, tobacco)
• raised ICP
• trauma

Question 3

Investigations to do in unilateral visual loss

Answer 3

VEP/MRI (optic neuritis)

Fluorescein angiography (CRVO)

tonometry (glaucoma)

USS (haemorrhage/detachment)

Question 4

Optic Neuritis Ax

Answer 4

Inflam of optic nerve, associated with MS.

Other causes - infection (lyme, HIV), B12 deficiency, arteritis

Question 5

Optic neuritis presentation

Answer 5

Reduced acuity over days, pain on moving eye, exacerbated by heat or exercise.

Afferent pupillary defect

total colour blindness (dyschromatopsia)

Recovery normally occurs around 6 weeks

Question 6

Optic neuritis treatment

Answer 6

Steriods help pain and hasten recovery

Question 7

MS typical presentation

Answer 7

Optic neuritis 1st presentation

spastic paraparesis

cerebellar (dysarthria, tremor, nystagmus)

Lhermittes (electric) Uhthoffs (bath)

UMN signs

afferent pupillary defect

Question 8

MS investigations

Answer 8

MRI - multiple plaques disseminated in place and time

LP - oligoclonal bands

Electrophysiological tests - prolonged evoked potentials

Question 9

MS Mx

Answer 9

Steroids (methylpred)

Disease modifying agents (natalizumab, alemtuzumab) (beta interferon)

Muscle relaxants (baclofen)

Question 10

Difference between clincally isolated symptom and MS?

Answer 10

CIS - first attack of MS

MS Dx- multiple CNS lesions -> symptoms that >24h disseminated in place and time (>1 month)

Question 11

Sites more likely to have demyelination plaque

Answer 11

1. optic nerve
2. cerival cord
3. brainstem
4. corpus callosum
5. periventricular region of cerebral hemispheres

Question 12

Diff diagnosis for recurrent black outs

Answer 12

• syncope
• epilespy
• non epileptic seizure

Question 13

Features in Hx suggesting epilepsy or syncope

Answer 13

Epilepsy - aura, incontinence, post ictal recovery slow and confused, tongue bite

Syncope - rapid recovery, prodrome - hot, dizzy, feel faint

Question 14

Pathophysiology of epileptic seizure

Answer 14

recurrent spontaneous intermittent abnormal electrical activity in part of the brain manifesting as seizures

Question 15

Pathophysiology of syncope

Answer 15

abrupt and transient loss of consciousness associated with loss of postural tone that follows a sudden fall in cerebral perfusion

Question 16

Role of EEG in recurrent blackouts

Answer 16

shows abnormalities in 70% cases if withint 24-48 hours after first seizure

only used to support clinical suspicion not in isolation

Question 17

Role of Neuro imaging in recurrent blackout

Answer 17

identify structural abnormalities that cause certain epilepsies

MRI if focal onset on history, examination or EEG

CT if MRI not availble or CI

Question 18

Complications of a stroke

Answer 18

Raised ICP

Aspiration

Pressure Sores

Depression

Cognitive impairment

Question 19

Thrombolysis +ve -VE

Answer 19

+ improves chances of pt being depended on discharge

• need to give in 4.5 hours (time is brain)
• haemorrhage (1 in 20)
• ischamic strokes only

Question 20

TACS symptoms and affected area

Answer 20

MCA/ACA

• unilat weakness (and or sensory) of AFL
• homonymous hemianopia
• higher cerebral dysfunction (dysphagia, visuospatial disorder)

Question 21

POCS symptoms

Answer 21

• cerebellar or brainstem syndromes
• locked in syndrome
• isolated homonymous hemianopia

Question 22

LACS symptoms

Answer 22

uni lat weakness of face and arm, arm and leg, or all 3

pure sensory loss

ataxic hemiparesis