Neurology

Question 1

What cranial nerves are implicated in vestibular schwannoma?

Answer 1

CN V, VII, and VIII

V = absent corneal reflex 
VII = unilateral facial numbness
VIII = vertigo, unilateral hearing loss

Question 2

Painful third nerve palsy indicates…?

Answer 2

Posterior communicating artery aneurysm

Question 3

What is the difference between a medical and surgical third nerve palsy?

Answer 3

Medical = pupil sparing (e.g. diabetic neuropathy)
Surgical = pupil affected, dilated (e.g. tumour)

Question 4

Jacksonian march suggests focal seizure in which lobe?

Answer 4

Frontal lobe

Jacksonian march = clonic movements travelling proximally

Question 5

What are the typical categories of seizure behaviours seen in different lobes?

E.g. frontal lobe causes ___ seizures

Answer 5

Temporal = HEAD (hallucinations, epigastric rising/emotional, automatisms, deja vu/dysphasia post-ictal)

Frontal = motor (e.g. Jacksonian march, head/leg movements, posturing, post-ictal weakness)

Parietal = sensory (e.g. paraesthesia)

Occipital = visual (e.g. floaters, flashes)

Question 6

Diagnostic investigation for acoustic neuromas?

Answer 6

MRI of cerebellopontine angle

Question 7

Nerve supplying extensor muscles of hand?

Answer 7

Radial nerve (inc. wrist extension, finger extension)

Question 8

Long term prophylaxis for cluster headaches?

Answer 8

Verapamil

Reduces blood vessel dilation, which is pathophysiology of cluster headaches

Question 9

What causes subacute combined degeneration of the cord?

Answer 9

B12 deficiency, usually 2º to pernicious anaemia

Question 10

Clinical signs in subacute combined degeneration of the cord

Answer 10

Dorsal columns and lateral corticospinal tracts implicated

Proprioception and vibration sensation lost first, progressing to distal paraesthesia
UMN signs in legs: Babinski positive, brisk knee jerk, absent ankle jerks

Question 11

Proptosis + absent corneal reflex should make you think of what cause?

Answer 11

Cavernous sinus thrombosis

Question 12

How does syringomelia present, and what parts of the spinal cord are implicated?

Answer 12

Cape-like loss of PAIN and TEMPERATURE sensation due to compression of the SPINOTHALAMIC tract fibres decussating in the anterior white commissure of the spine

Question 13

Describe Uhthoff’s phenomenon

Answer 13

Reduced visual acuity after exercise

It’s a feature of multiple sclerosis