Neuro week: Multiple Sclerosis, Parkinson's, Giant Cell Arteritis

Question 1

Symptoms of giant cell arteritis

Answer 1

• jaw/tongue claudication
• pain around temples
• scalp sensitivity
• vision loss/blurring/ double vision
• acute tinnitus
• fever, bruits, headache

Question 2

How is GCA diagnosed

Answer 2

Biopsy of temporal artery

Question 3

How is GCA treated

Answer 3

Steroids

Question 4

Diseases associated with GCA

Answer 4

• polymyalgia rheumatica
• SLE
• RA
• severe infections

Question 5

Definition of multiple sclerosis

Answer 5

• Inflammatory plaques of demyelination
• Disseminated in space and time
• 2 separate episodes that occured <1 month apart

Question 6

Which viruses are linked to multiple sclerosis

Answer 6

EBV

HHV6

Question 7

3 most common presentations of multiple sclerosis

Answer 7

1. optic neuritis
2. brainstem demyelination
3. spinal cord lesions

Question 8

Signs of evidence of brainstem demyelination

what would patient present with

Answer 8

• limb weakness
• sudden diplopia
• vertigo (but no tinnitus)
• nystagmus

Question 9

What condition is bilateral internuclear opthalmoplegia pathognomonic of

Answer 9

Multiple sclerosis

Question 10

What happens in bilateral internuclear opthalmoplegia

Answer 10

 Disorder of conjugate lateral gaze
 Affected eye cannot adduct fully
 Contralateral abducts with nystagmus

Question 11

3 types of multiple sclerosis (from most common to least common)

Answer 11

1. Relapsing-remitting
2. Secondary progressive
3. Primary progressive

Question 12

What sensory disorders might one find in a patient with multiple sclerosis

Answer 12

• Dysaesthesia
• Paraesthesia
• Reduced vibration sensation
• Trigeminal neuralgia

Question 13

What motor disorders might one find in a patient with multiple sclerosis

Answer 13

• Trunk and limb ataxia
• intention tremor
• monotonous speech
• falls
• spastic weakness

Question 14

What investigations to do for multiple sclerosis

Answer 14

• MRI brain and spinal cord
• CSF analysis for oligoclonal bands
• evoked potentials (measure brain electrical activity)

Question 15

3 cardinal symptoms for Parkinsons

Answer 15

• Bradykinesia
• Shuffling gait
• Tremor

Question 16

Parkinsons motor symptoms

Answer 16

o	Akinesia
o	Tremor
o	Cogwheel rigidity
o	Postural & gait changes
o	Speech & swallowing
o	Hypomimia: blank look

Question 17

Parkinsons prodromal premotor symptoms motor symptoms

Answer 17

o	Anosmia 
o	Depression/anxiety
o	Aches & pains
o	REM sleep behaviour disorder
o	Urinary urgency
o	Hypotension
o	Constipation
o	Restless legs syndrome

Question 18

Pathogenesis of atypical Parkinsonism

Answer 18

Neurodegenerative disorders affect the basal ganglia

Question 19

Types of atypical Parkinsonism

Answer 19

o Progressive supranuclear palsy
o Multiple system atrophy
o Cortico-basal degeneration
o Wilson’s disease: copper deposits in basal ganglia

Question 20

What drugs may cause drug-induced Parkinsonism

Answer 20

• anti-emetics eg metoclopramide

- tranquilisers to treat psychosis