Neurological Questions

Question 1

What are the symptoms of Parkinsonism?

Answer 1

• Bradykinesia
• Tremor
• Rigidity
• Postural instability

Question 2

Motor symptoms of Parkinson’s

Answer 2

Slow movements, Difficulty initiating movement, shuffling gait with reduced arm swing and turning en bloc

Resting ‘pill-rolling’ tremor

Cogwheel rigidity

Micrographia
Hypomimia
Postural instability

Question 3

Non-motor symptoms of parkinson’s

Answer 3

Anosmia (smell blindness)
Sleep disturbance
Constipation
Psychiatric symptoms:
- Depression
- Anxiety
- Dementia: usually develops after motor symptoms, unlike in lewy-body dementia

Question 4

Investigation for Parkinson’s

Answer 4

It is a clinical diagnosis and should be suspected in a patient who has bradykinesia and at least one of the following:
- Tremor
- Rigidity
- Posteral instability

Investigations to consider:

-MRI Brain: may help exclude other causes of symptoms
-SPECT (DaT scan): will show reduced dopamine uptake in the basal ganglia

Question 5

Management of Parkinson’s

Answer 5

• Levodopa and decarboxylase inhibitor
• Dopamine agonist

Question 6

Clinical manifestations of subdural haemorrhage

Answer 6

• Reduced GCS: loss of consciousness right after the injury or in the ensuing days to weeks as the haematoma increases in size.
• Headaches
• Vomiting
• Seizures
• Sometimes there can be focal neurological symptoms e.g. muscle weakness, unequal pupils, hemiparesis or sensory problems

Question 7

Features of subdural haemorrhage

Answer 7

Between the arachnoid mater and the inner layer of the dura mater
Crescent Shape
Cross suture lines

Question 8

Clinical manifestations of an extradural (epidural) haemorrhage

Answer 8

• Reduced GCS: loss of consciousness after the trauma due to concussion
• There might be a lucid interval after initial trauma if there is a slower bleed. This is followed by rapid decline.
• Headaches
• Vomiting
• Confusion
• Seizures
• Pupil dilation if bleeding continues
• May be focal neurological symptoms e.g. muscle weakness, hemiparesis, abnormal plantar reflex (upgoing plantar) or sensory problems

Question 9

Epidural haemorrhages

Answer 9

Between the outer layer of the dura mater and the skull

So not cross suture lines

Biconvex shape

Question 10

Clinical manifestations of migraine

Answer 10

• Severe, unilateral, pulsating headache lasting up to 72 hours
  (In children migraines are more commonly bilateral, shorter-lasting and associated with gastrointestinal symptoms such as ab pain
• Nausea and vomiting
• photophobia and photophobia
• Aura

Question 11

Symptoms of cluster headaches

Answer 11

Autonomic symptoms:
- lacrimation
- conjunctival injection (red eye)
- nasal congestion
- rhinnorrhoea (nasal discharge)
- ptosis
- miosis
- facial sweating

Nausea and vomiting
Photophobia, with agitation and restlessness

Question 12

Management of cluster headaches

Answer 12

All patients should be referred to a neurologist

Acute management:
- Triptans (subcutaneous or intranasal)
- High flow oxygen
- Avoid triggers
- The following drugs should be avoided: paracetamol, NSAIDs, opioids, ergots, and oral triptans

Prophylaxis:
- verapamil