Neurology

Question 1

Status epilepticus

Answer 1

Seizure > 5 mins

1st line: prehospital- rectal diazepam
Hospital with IV - IV lorazepam
then 2nd line: phenytoin/ phenobarbital
then 3rd line: GA

Question 2

Normal pressure hydrocephalus

Answer 2

Triad of incontinence, dementia and ataxia
Absence of papilloedema and normal opening pressure on CSF
Treat with ventriculoperitoneal shunt

Question 3

MS

Answer 3

Demyelination of neurones(motor+sensory) disseminated in space and time

Often young women with optic neuritis(acute painful eyes with reduction of vision, horizontal nystagmus on examination), red desaturation can happen(red is kinda pinkish)

O/E RAPD (relative afferent pupillary defect-what do you see?)- this is called Marcus Gunn pupil

Then limb weakness and other neuro symptoms

Types: relapse-remitting (most common)
Secondary progressive: relapse-remitting then straight downhill
Primary progressive: downhill from the start( rare)

Dx: MRI brain+spine first line and gold standard(see demyelination damage, “thumb printing” signs)
CSF: oligoclonal bands
Visual evoked potential(see how fast nerve signal travel in optic nerve, reduced in MS)

Mx:
Acute flare-IV methylpred for 5 days
Maintenance: interferon B

Question 4

Idiopathic intracranial hypertension

Answer 4

Typically OBESE women in their 30s

Diffuse headache worse in the morning and relieved by standing
Transient visual disturbances and diplopia

Complication: Papilloedema and long term can lead to damage of optic nerve

CT and MRI: normal ventricular sizes

Tx: LOSE WEIGHT!