Neurology

Question 1

What are the signs of an anterior cerebral artery stroke?

Answer 1

Contralateral hemiparesis and sensory loss, lower extremity > upper

Question 2

What are the signs of a middle cerebral artery stroke?

Answer 2

Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia

Question 3

What are the signs of a posterior cerebral artery stroke?

Answer 3

Contralateral homonymous hemianopia with macular sparing
Visual agnosia

Question 4

What is Weber syndrome?

Answer 4

(branches of the posterior cerebral artery that supply the midbrain)
Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity

Question 5

What is lateral medullary syndrome?

Answer 5

Posterior inferior cerebellar artery stroke
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

Question 6

What are the signs of an Anterior inferior cerebellar artery stroke (lateral pontine syndrome)?

Answer 6

Similar to posterior inferior cerebellar:
(Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus)
BUT ALSO Ipsilateral: facial paralysis and deafness

Question 7

What are the signs of a Lacunar stroke?

Answer 7

Present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
Strong association with hypertension
Common sites: basal ganglia, thalamus and internal capsule

Question 8

Within what time period can a patient be offered alteplase (thrombolysis) for a stroke?

Answer 8

4.5 hrs

Question 9

When can thrombectomy be offered to those with a stroke?

Answer 9

1. Can be offered < 6hrs from onset + confirmed proximal anterior circulation occlusion (with thrombolysis if <4.5hrs)
2. Offered 6-24hrs after onset if confirmed proximal anterior circulation occlusion + potential to salvage brain tissue

Question 10

What long-term therapy should someone be put on post stroke?

Answer 10

Clopidogrel
2nd line: Aspirin + dipyridamole

Question 11

What treatment should be given for Tonic or atonic seizures?

Answer 11

males: sodium valproate
females: lamotrigine

Question 12

What treatment should be given for Myoclonic seizures?

Answer 12

males: sodium valproate
females: levetiracetam

Question 13

What treatment should be given for Absence seizures?

Answer 13

first line: ethosuximide
second line:
male: sodium valproate
female: lamotrigine or levetiracetam

Question 14

What treatment should be given for Focal seizures?

Answer 14

first line: lamotrigine or levetiracetam

Question 15

What treatment should be given for Generalised tonic-clonic seizures?

Answer 15

males: sodium valproate
females: lamotrigine or levetiracetam

Question 16

What are the features of a temporal lobe seizure?

Answer 16

Aura: rising epigastric sensation, déjà vu or hallucinations
Automatisms: lip smacking, grabbing

Question 17

What neurological features are NOT featured in MND?

Answer 17

External ocular muscles
Cerebellum

Question 18

What are the features of Amyotrophic lateral sclerosis (most common type MND)?

Answer 18

LMN signs in arms
UMN signs in legs

Question 19

What are the features of Primary lateral sclerosis?

Answer 19

UMN signs only

Question 20

What are the features of Progressive muscular atrophy?

Answer 20

LMN signs only
affects distal muscles before proximal

Question 21

What are the features of Progressive bulbar palsy?

Answer 21

Palsy of the tongue, muscles of chewing/swallowing and facial muscles

Question 22

What management can be given to patients with MND (include supportive care)?

Answer 22

Riluzole (prolongs life)
Resp care - BIPAP
Nutrition- PEG feed