Neurology

Question 1

When to do LP for suspected SAH

Answer 1

Within 12 hours; Check for spectrophotometry for haemoglobin breakdown products instead of xanthochromia

Question 2

Treatment of acute dystonia?

Answer 2

IV procyclidine (dystonia usually precipitated by anti-psychotics and anti-emetics)

Question 3

What is Riboflavin used for?

Answer 3

The hydrogen-transfer chain in the mitochondira (the redox processes in the production of ATP)

Question 4

Rapid decline in cognitive function in young person with myoclonus…

Answer 4

Likely CJD
Diagnose with MRI

Question 5

Treatment for cluster headaches

Answer 5

Sumatriptan
Can use veramapil or lithium if headaches and frequent for prophylaxis.

Question 6

Pyramidal lesions in stroke, what sxs?

Answer 6

Extensor arms + flexor legs
i.e. will present with foot drop and elbow and wrist flexed

Question 7

Second line test for MS?

Answer 7

Visual evoked potentials - detects demyelination of the optic nerve

Question 8

Where is aneurysm if patient has 3rd nerve palsy?

Answer 8

Posterior communicating artery aneurysm

Question 9

Neuralgic amyotrophy

Answer 9

Brachial neuritis - autoimmune conditon after infection, vaccination, trauma, surgery, child birth.
Starts with intense pain around the shulder then weakness of the affected limb i.e. winging of scapula. Recovery is usually spontaneous after a few months.

Question 10

Anterior cord syndrome

Answer 10

1. muscle weakness (the corticospinal tracts are involved)
2. bilateral loss of pain and temperature sensation (the spinothalamic tracts are involved)
3. urinary incontinence
   (the descending autonomic tracts are involved)

The posterior columns are spared (vibration and proprioception)

Caused by compression injury, fractures, herniation and myelopathy.

Question 11

Brown-sequard syndrome

Answer 11

Ipsilateral findings
1. weakness
- lower motor neuron symptoms at the level of the lesion
- upper motor neuron symptoms below the level of the lesion
2. loss of proprioception, vibration, light touch, and tactile sense

Contralateral findings
1. loss of pain and temperature sensation usually 1 to 2 levels below level of the lesion

Caused by knife injury/ bulllet and MS

Question 12

Posterior cord syndrome

Answer 12

1. loss of proprioception and vibration sense
2. variable weakness
3. bladder dysfunction

Causes by tabes dorsalis, friedreich ataxia, MS

Question 13

Conus medullaris

Answer 13

1. sphincter dysfunction
2. flaccid paralysis of the bladder and rectum
   impotence
3. saddle anesthesia (more commonly bilateral)
   S3-S5 involvement

Cause by disc herniation, trauma, malignancy

Question 14

Cause equina syndrome

Answer 14

1. asymmetric multiradicular pain
2. leg weakness
3. bladder and rectal sphincter paralysis
4. sensory loss
5. saddle anesthesia (more commonly unilateral)

Cause by disc herniation, lumbar spinal stenosis, malignancy

Question 15

Subacute bilateral weakness and loss of sensation with autonomic dysfunction e.g. sexual dysfunction and upper motor neurone signs e.g. upward babinski

Answer 15

Transverse myelitis (a neuro inflammatory disease of the spinal cord)
Affects anterior spinothalamic tracts - sensation
Lateral corticospinal tracts - UMN signs
Dorsal column - vibration
Can be post infection e.g. pneumonia/ viral infection