Neuro: other

Question 1

If neuro symptoms, abdo pain and psychiatric/dermatological manifestations - think of…?

Answer 1

Porphyrias

Question 2

Excessive daytime sleepiness:

a) differentials
b) assessment tool
c) investigations

Answer 2

a) Narcolepsy (often with cataplexy), OSA, hypnotic drugs, SOL, epilepsy
b) Epworth Sleepiness Scale

c) - PSG with Multiple Sleep Latency Test (MSLT)
- MRI (exclude SOL)
- EEG (exclude epilespy)
- ECG (exclude arrhythmias)

Question 3

Management of narcolepsy

a) Must inform…?
b) Conservative
c) Medication - 1st line? (cautions)
d) Mediation - 2nd line?

Answer 3

a) DVLA until symptoms controlled
b) Encourage good sleep hygiene (8h/night) and strategic daytime naps

c) - Modafinil
(avoid if < 18, pregnant/ breastfeeding, uncontrolled HTN; caution if previous psychosis, alcohol misuse, mania or depression)

d) 2nd line: methylphenidate