Neurology

Question 1

A 26-month-old male patient is seen in the emergency room for a generalized seizure that took place 1 hour ago. The mother witnessed the seizure and says it lasted 2-3 minutes. The patient’s past medical history is unremarkable, except for two episodes of otitis media. Temperature 102°F (38°C). The child is awake, interactive, and consolable. The left tympanic membrane appears erythematous and inflamed, with a poor light reflex and a bulging appearance. There are no meningeal signs, and the neurological examination is unremarkable.

What is the next step?

Answer 1

Observation as this child is presenting with a febrile seizure and is less than 6 months

LP is required in infants less than 6 months

Question 2

What are the hallmark symptoms of Parkinson Disease?

What usually appears first?

Answer 2

TRAP: Tremor, rigidity, akinesia (bradykinesia, postural instability

Tremor

Question 3

What are some side effects associated with Levodopa?

Answer 3

Nausea, vomiting, orthostatic hypotension, smnolence, and headache

Long-term use associated with “wearing off” effect

Question 4

A 42-year-old man presents to the office with concerns that his face “feels funny.” He woke up this morning and discovered that the right side of his face was not moving properly. His taste feels diminished, and he notes difficulty drinking liquids from a cup. He reports a preceding history of right ear pain for the past 2 days. He is concerned he is having a stroke. His medical history is pertinent for essential hypertension, which is controlled with lisinopril. Blood pressure is 118/76 mm Hg, heart rate is 78 beats/minute, respiratory rate is 14 breaths/minute, and oxygen saturation is 99%. The patient is afebrile. Physical examination demonstrates flattening of the right nasolabial fold and inability to raise the right eyebrow. The patient cannot fully shut the right eye. There are no other neurologic findings present. Based on the suspected diagnosis, what is the most likely underlying cause of the patient’s condition?

Answer 4

Bells Palsy, inflammation of the seventh CN (facial nerve)

Question 5

Is alcohol use a trigger for cluster headaches?

What neurological condition is improved with small amounts of alcohol?

Answer 5

Yes

Essential Tremor (Familial Tremor)

Question 6

A 68-year-old woman presents to the office with a family member for evaluation of memory loss. While the patient reports no problems with her memory, the family member notes the patient has been increasingly forgetful over the past 9 months. She calls family members multiple times per day to ask the same question. She has been less sociable. She recently got lost when driving home from the post office, which is less than a mile from her home. The patient’s medical history is pertinent for well-controlled hypertension, for which she is prescribed losartan. Vital signs show a blood pressure of 118/60 mm Hg, heart rate of 64 beats per minute, respiratory rate of 18 breaths/minute, and oxygen saturation of 97%. The patient is afebrile. Physical examination is without focal neurologic findings, but a Mini-Mental State Examination results in a score of 18. What is the most likely diagnosis?

What dementia is associated with stroke and history of hypertension?

Answer 6

Alzheimer disease

Vascular Dementia (often co-exists with Alzheimer’s)