Neurology

Question 1

Define seizure types

Answer 1

1- Focal:
Simple partial seizure “intact awareness”
Complex partial seizure “impaired awareness”

2- Generalized
Tonic-clonic “grand mal”
Absence seizure “petit mal”

Question 2

Äbsence seizure
1- Usual age?
2- Feature?
3- IS there an aura?
4- EEG finding?
5- Initial treatment?

Answer 2

5-8 years old

Staring, can accompanied by simple automatism “lip smacking, picking at clothes”. Can recurs hundred time a day

No aura

Atypical absence seizure are associated with myoclonic jerk, and more difficult to treat “1-2 Hz spikes”

EEG: 3 Hz spike-and-slow wave discharge

Initial treatment is Ethosuximine

Question 3

Most common cause of recurrent seizure

Answer 3

Medication non complaince

Question 4

Four factors lower seizure threeshold

Answer 4

1- Medications
2- Stressors
3- Infection
4- worsening of seizure cause such as tumor

Question 5

Definition of status epilepticus:

Answer 5

• Seizure lasting more than five mins, or 2 seizure attack without fully regaining the consciusness
• Duration cutoff differ according to seizure type

1: Generlized: 5m
2: Focal and absence 10-15 mins

Question 6

Indications to hospitalization in seizure?

Answer 6

1- CNS mets, mass, infection (abccess or meningoenchpalitis)
2- Severe hyponatermia
3- Alcohol or benzo withdrawl
4- recurrent seizure despite adequate tx
5- status epilepticus
5- eclampsia
6- seizure due to drug toxicity

Question 7

What is the most common cause of new onset seizure in elderly?

Answer 7

Stroke (more than half)

Others: brain tumor, aneurysm AVM, and alzahaimar

Question 8

Can clinical presentation distinguish ischemic versus hemorrhagic stroke?

Answer 8

CT is the only way.

Favoring ischemic: DM, HTN, Afib, MI, Intermittent claudication

Favoring haemorrghic: SMOKING, alcohol, sudden severe headache followed by N/V, seizure, altered mental status

Question 9

Transient Monocular blindness (amaurosis fugax)

Answer 9

Ipsilateral carotid artery thrombosis emblems

Question 10

Stroke prevention?

Answer 10

• Control HTN
• Smoking casseastion
• Control other CVD risk factors
• Heavy Alcohol limitation

RCTs have shown no benefit to antioxidants vitamins, polyunsaturated fatty acids or fish oil, or homocysteine lowering vitamins in reducing stroke risk

Question 11

Alcohol and risk of stroke

Answer 11

• Heave : increase
• Moderate alcohol use carries a lower risk of stroke than abstinence

Question 12

Subarachnoid hemorrhage LP findings?

Answer 12

• Crenated RBC
• Present D dimer
• xanthochromia

Question 13

High intensity in temporal lobe MRI? Fever + headache + confusion

Answer 13

Herpes simplex enchaphlitis

Question 14

Predictors of worse outcomes in patients with herpes simplex encephalitis?

Answer 14

1- LONG DURATION OF SYMPTOMS BEFORE STARTING ACYCLOVIR
2- lower level of consciousness at admission
3- older age

Question 15

Coughing spell, followed by sudden onset unilateral ptosis and neck pain, and contralateral weakness

Answer 15

Carotid dissection