Neurology

Question 1

The bleeding in a subarachnoid hemorrhage occurs between?

Answer 1

the arachnoid and pia mater.

Question 2

Multiple system atrophy (MSA)

Answer 2

A degenerative neurologic disorder that presents with symptoms of Parkinsonism, unresponsive to levodopa, cerebellar ataxia, orthostatic hypotension, incontinence, impotence, and other autonomic symptoms. Definitive diagnosis may only be made on autopsy evaluation, with CNS tissue showing numerous glial cytoplasmic inclusions.

Question 3

Neurofibromatosis Type I

Answer 3

Mutation in NF1 tumor
suppressor gene on
chromosome 17.
Café-au-lait spots, Intellectual disability,
Cutaneous neurofibromas, Lisch
nodules (pigmented iris hamartomas),
Optic gliomas, Pheochromocytomas,
Seizures/focal neurologic Signs (often
from meningioma), bone lesions (eg,
sphenoid dysplasia).

Question 4

Neurofibromatosis Type II

Answer 4

Mutation in NF2
tumor suppressor
gene (merlin) on
chromosome 22.
Bilateral vestibular schwannomas, juvenile
cataracts, meningiomas, ependymomas.

Question 5

Electrolyte disturbance in subarachnoid hemorrhage

Answer 5

Hyponatremia after SAH (occurring in an estimated 10-40% of cases).
Manifests within 10 days of initial presentation.
The 2 primary/suspected causes of hyponatremia in SAH include syndrome of inappropriate antidiuretic hormone secretion (SIADH) versus cerebral salt wasting.

Question 6

Epidural vs subdural hematoma

Answer 6

Epidural hematoma:
-High velocity head trauma.
- Patients will have an initial loss of consciousness at the time of injury, followed by a lucid interval lasting minutes to hours, and then rapid deterioration in mental status and loss of consciousness.
- Rupture of the middle meningeal artery which runs along the inside of the skull.
-CT will demonstrate a lens shaped hyperdenisty with or without overlying skull fracture or scalp hematoma.

Subdural hematoma:
- Rupture of cortical veins
- Somnolent and comatose
- Crescent shaped hyperdense collection between the brain and skull.

Question 7

Lacunar Stroke

Answer 7

Thalamus: unilateral motor weakness and dysarthria.

Other typical lacunar syndromes include sensory stroke if the putamen is involved, ataxic hemiparesis, and dysarthria-clumsy hand syndrome.

The most significant risk factor for lacunar stroke is hypertension

Question 8

Cauda equina syndrome

Answer 8

affects the spinal nerve rootlets.
Asymmetric motor weakness, saddle anesthesia, hyporeflexia, and late-onset bowel and bladder dysfunction.

Question 9

Conus medullaris syndrome

Answer 9

Sudden-onset severe back pain with perianal anesthesia, symmetric motor weakness, hyperreflexia, and early onset bowel and bladder dysfunction.

Question 10

The most appropriate treatment for myasthenia gravis is?

Answer 10

a long-acting acetylcholinesterase inhibitor such as pyridostigmine.