Neurology Flashcards

Question

describe the different types of aphasia

Answer 1

Wernicke's (receptive) aphasia > lesion of superior temporal gyrus > usually supplied by inferior division of left MCA > features - sentences that make no sense - word substitution - neologism - speech remains fluent - "word salad" - comprehension is impaired Broca's (expressive) aphasia > lesion of inferior frontal gyrus > usually supplied by superior division of left MCA > speech is non-fluent, laboured and halting > repetition is impaired > comprehension is normal Conduction aphasia > usually due to stroke affecting arcuate fasciculus > speech is fluent but repetition is poor > aware of errors being made > comprehension is normal Global aphasia > severe expressive and receptive aphasia > may still be able to communicate using gestures

Answer 2

aka myalgic encephalomyelitis (ME) diagnosed after at least 3 months of disabling fatigue affecting mental and physical function >50% of the time in the absence of other disease which can explain symptoms features - fatigue - sleep problems - muscle/joint pains - headaches - painful lymph nodes - cognitive dysfunction - physical or mental exertion makes symptoms worse management - energy management - CBT

Answer 3

Reduced blood carbon dioxide to induce cerebral vasoconstriction

Answer 4

measure of disability or dependence in activities of daily living in stroke patients

Answer 5

causes - trauma e.g. spinal cord transection features - bradycardia - hypotension management - vasopressors

Answer 6

Acute: - analgesia NSAIDs or paracetamol + triptans > avoid opioids - antiemetic: metoclopramide > prokinetic agent that helps to relieve gastric stasis that occurs during acute migraine attack > consider even in cases without nausea Prophylaxis: - topiramate (teratogenic) or propranolol

Answer 7

PO ciprofloxacin or rifampicin > one dose for close contacts within last 7 days

Answer 8

classically seen in young overweight females features - headache - blurred vision - papilloedema - enlarged blind spot - sixth nerve palsy - high pressure features: worse on coughing/sneezing/lying flat/leaning forwards associated with tetracycline antibiotics investigations - lumbar puncture: opening pressure values >25 cmH2O - CT brain: enlarged arachnoid outpouchings, prominent perivascular spaces management - weight loss - semaglutide and topiramate - carbonic anhydrase inhibitors e.g. acetazolamide - repeated LP - temporary measure - surgery: > optic nerve sheath decompression and fenestration > lumboperitoneal / ventriculoperitoneal shunt

Answer 9

downward displacement or herniation of cerebellar tonsils through foramen magnum malformation may be congenital or acquired through trauma features - non-communicating hydrocephalus may occur as a result of obstruction of CSF flow - headache - syringomyelia

Answer 10

autosomal dominant condition which usually affects both upper limbs Features - postural tremor: worse if arms outstretched - improved by alcohol and rest - most common cause of titubation (head tremor) Management - propranolol is first-line - primidone is sometimes used

Answer 11

myasthenic crisis - acute respiratory failure characterised by FVC <1L - accessory muscle use Management > plasmapheresis > intravenous immunoglobulins > ventilatory support: low threshold for intubation

Answer 12

autoimmune disorder due to autoantibodies against ACh receptors Features - muscle fatiguability - muscles become progressively weaker during periods of activity and slowly improve after periods of rest - extraocular muscle weakness: diplopia - proximal muscle weakness: face, neck, limb girdle - ptosis - dysphagia Associations > thymomas in 15% > autoimmune disorders: pernicious anaemia, autoimmune thyroid disorders, rheumatoid, SLE > thymic hyperplasia in 50-70% Exacerbating factors > penicillamine > beta-blockers > lithium > phenytoin > antibiotics: gentamicin, macrolides, quinolones, tetracyclines > quinidine, procainamide Investigations > single fibre electromyography > CT thorax - exclude thymoma > antibodies to acetylcholine receptors > Tensilon test: IV edrophonium reduces muscle weakness temporarily Management > long-acting acetylcholinesterase inhibitors: pyridostigmine is first-line > immunosuppression: prednisolone initially > azathioprine, cyclosporine, mycophenolate mofetil > thymectomy

Answer 13

Wernicke's encephalopathy is a neuropsychiatric disorder caused by thiamine deficiency which is most commonly seen in alcoholics Rarer causes; persistent vomiting, stomach cancer, and dietary deficiency Classic triad: ophthalmoplegia/nystagmus, ataxia and encephalopathy Features > oculomotor dysfunction > nystagmus (the most common ocular sign) > ophthalmoplegia: lateral rectus palsy, conjugate gaze palsy > gait ataxia > encephalopathy: confusion, disorientation, indifference, and inattentiveness > peripheral sensory neuropathy Investigations > decreased red cell transketolase > MRI Treatment: urgent replacement of thiamine > IV Pabrinex (vitamin B/C) If not treated Korsakoff's syndrome may develop > antero- and retrograde amnesia > confabulation

Answer 14

occur in clusters lasting 4-12 weeks > clusters typically occur once a year More common in men, smokers and alcohol drinkers Features -intense sharp, stabbing pain around one eye - pain once or twice a day, each episode lasting 15 mins - 2 hours - restless / agitatated during attack - clusters typically last 4-12 weeks - ipsilateral autonomic features > conjunctival injection (redness) > orbital oedema > lacrimation > miosis and ptosis > nasal congestion > facial sweating Investigations - neuroimaging - underlying brain lesions are sometimes found > MRI with gadolinium contrast: investigation of choice Management - acute: > 100% oxygen > subcutaneous triptan - prophylaxis: verapamil

Answer 15

Eye-opening > eyes open spontaneously (4) > eyes open to voice (3) > eyes open to pain (2) > no eye-opening (1) Verbal response > orientated (5) > confused (4) > words (3) > incomprehensible sounds (2) > no verbal response (1) Motor resopnse > obeys commands (6) > localises pain (5) > normal flexion (4) > abnormal flexion (3) > abnormal extension (2) > no motor response (1)

Answer 16

clinical features - headache (insidious or sudden onset) - signs of increased ICP > vomiting > papilloedema > focal / generalised seizures risk factors: thrombophilia, female, pregnancy, COCP, infections (mastoiditis, otitis, sinusitis) diagnosis: MR venogram management - anticoagulation: heparin or warfarin - treat underlying cause if possible

Answer 17

Absolute - Previous intracranial haemorrhage - Seizure at onset of stroke - Intracranial neoplasm - Suspected subarachnoid haemorrhage - Stroke / traumatic brain injury in preceding 3 months - LP in preceding 7 days - GI bleed in preceding 3 weeks - Active bleeding - Pregnancy - Oesophageal varices - Uncontrolled hypertension Relative - Concurrent anticoagulation - Active diabetic haemorrhagic retinopathy - Suspected intracardiac thrombus - Major surgery / trauma in the preceding 2 weeks

Answer 18

clopidogrel 75mg daily lifelong (first-line) aspirin plus MR dipyridamole (if clopidogrel is contraindicated) Carotid artery endarterectomy if patient has suffered stroke / TIA in the carotid territory and is not severely disabled

Answer 19

aspirin 300mg orally or rectally - once haemorrhagic stroke has been excluded > continue aspirin 300mg daily for 2 weeks then clopidogrel 75mg daily long-term If AF - anticoagulants should not be started until 14 days have passed from the onset of an ischaemic stroke if cholesterol is > 3.5 mmol/l - commence statin > delay treatment until after 48 hours due to risk of haemorrhagic transformation Thrombolysis with alteplase for acute ischaemic stroke > if within 4.5 hours of onset of stroke symptoms and haemorrhage definitively excluded Thrombectomy for acute ischaemic stroke > within 6 hours of symptom onset, PLUS intravenous thrombolysis (if within 4.5 hours) > consider extended 6-24h if potential to salvage tissue as shown by CT perfusion or diffusion-weighted MRI showing limited infarct core volume ROSIER score used in medical settings

Answer 20

Clinical features - thunderclap headache > maximal intensity <5mins > sudden onset severe occipital headache - meningism (photophobia, neck stiffness) - nausea and vomiting - coma - seizures - neurological symptoms: visual changes, dysphasia, focal weakness, reduced consciousness - ECG changes - ST elevation risk factors: female sex, smoker, hypertension, black ethnic origin, excessive alcohol Diagnosis - Non-contrast CT head <6h after onset: if negative, consider alternative diagnosis - if CT >6h after onset is negative do LP after 12h (confirm xanthochromia) - after spontaneous SAH is confirmed > CT intracranial angiogram +/- digital subtraction angiogram Management > supportive: bed rest, analgesia, VTE prophylaxis, discontinuation of antithrombotics > nimodipine for prevention of vasospasm - neurosurgical referral due to risk of aneurysm rebleeding > endovascular coiling by interventional neuroradiologist (most common) > if severe, neurosurgical clipping or craniotomy

Answer 21

- Re-bleeding - hydrocephalus (treat with LP, external ventricular drain or long-term ventriculoperitoneal shunt) - vasopasm > prevention with nimodipine - hyponatraemia (due to SIADH) - Seizures > treat with anti-epileptics - Torsades de Pointes

Answer 22

- Levodopa (co-careldopa contains levodopa and carbidopa) > reduced effectiveness with time - Carbidopa: DOPA decarboxylase inhibitor - dopamine receptor agonists e.g. bromocriptine, cabergoline, apomorphine > highest chance of inhibition disorders - COMT inhibitors e.g. entacapone - MAO-B inhibitors e.g. selegiline - amantadine

Answer 23

- dry mouth - anorexia - CVS: palpitations, postural hypotension, arrhythmias - psychosis, hallucinations - on-off phenomenon - end-of-dose dyskinesia

Answer 24

clinical features - Bradykinesia > test with finger-tap test and pronation-supination test - Unilateral pill-rolling tremor > asymmetrical, 4-6 Hz, enhanced by anxiety - shuffling gait with reduced arm swing - Postural instability - Leadpipe rigidity or cogwheeling Neuropsychiatric - Anxiety, depression - Hallucinations - REM sleep disorders - Cognitive impairment (Parkinson's disease dementia) > motor symptoms ongoing at least a year before the emergence of dementia Autonomic - Altered sense of smell (hyposmia) - Constipation Genitourinary - Incontinence - Nocturia, frequency - Erectile dysfunction Myalgia Hyperhidrosis (sweating) Hypomimia Infrequency of eye blinking Hypophonia

Answer 25

- Reduced tone - Hyporeflexia - Fasciculations - Paresis - Weakness in a root innervated pattern - muscle atrophy

Answer 26

Features - present for 15 days or more per month - developed or worsened whilst taking regular symptomatic medication - patients using opioids and triptans are at most risk - may be psychiatric co-morbidity Management - simple analgesics and triptans should be withdrawn abruptly (may initially worsen headaches) - opioid analgesics should be gradually withdrawn

Answer 27

typical antipsychotics e.g. haloperidol antiemetics e.g. metoclopramide, prochlorperazine > symptoms are likely to be bilateral in drug-induced parkinsonism

Answer 28

treat the underlying cause and modify environment if not working then haloperidol / olanzapine can be used if Parkinson's use atypical antipsychotics like quetiapine or clozapine

Answer 29

features - vertigo upon neck extension (looking up) - exacerbated by changes in head position - falls in elderly patients risk factors - CVD, atherosclerosis

Answer 30

posterior communicating artery aneurysm after trauma an oculomotor nerve palsy + hemiparesis can be a sign of transtentorial / uncal herniation (medial aspect of temporal lobe compressing CN III and cerebral peduncle)

Answer 31

Brown-Sequard syndrome - aka spinal cord lateral hemisection - ipsilateral spastic paresis below lesion - ipsilateral loss of proprioception and vibration sensatoin - contralateral loss of pain and temperatures sensation friedrich's ataxia - same as above + cerebellar ataxia, intention tremor anterior spinal artery occlusion - bilateral spastic paresis - bilateral loss of pain and temperature sensation neurosyphilis (tabes dorsalis) - loss of proprioception and vibration sense as dorsal columns are affected

Answer 32

ketogenic diet

Answer 33

diagnosis requires dissemination of demyelinating lesions in time and space - MRI brain + spinal cord with contrast > high signal T2 lesions > periventricular plaques > Dawson fingers - +ve Hoffman's sign - CSF > oligoclonal bands > increased intrathecal synthesis of IgG - Visual evoked potentials > delayed but well-preserved waveform risk factors: EBV infection, multiple genes, low vitamin D, smoking, obesity

Answer 34

ACA > contralateral hemiparesis and sensory loss > lower extremity > upper MCA > contralateral hemiparesis and sensory loss > upper extremity > lower extremity > aphasia > contralateral homonymous hemianopia PCA > Contralateral homonymous hemianopia with macular sparing > Visual agnosia Weber's syndrome (branches of PCA supplying midbrain) > contralateral upper and lower limb weakness > ipsilateral CN III palsy PICA (lateral medullary syndrome, Wallenberg syndrome) > ipsilateral facial pain and temperature loss > contralateral limb/torso pain and temperature loss > ataxia, nystagmus > ipsilateral Horner's syndrome AICA (lateral pontine syndrome) > similar to Wallenberg's but ipsilateral facial paralysis and deafness also > reduced GCS, paralysis, bilateral pinpoint pupils Retinal/ophthalmic artery: amaurosis fugax Basilar artery: locked in syndrome Lacunar strokes present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia > strong association with hypertension > common sites include the basal ganglia, thalamus and internal capsule

Answer 35

Idiopathic inflammatory demyelinating disease of the CNS Acute episodes of inflammation are associated with focal neurological deficits visual symptoms - optic neuritis - optic atrophy - Uhthoff's phenomenon: worsening of vision following rise in body temperature - internuclear ophthalmoplegia sensory symptoms - pins/needles - numbness - trigeminal neuralgia - Lhermitte's syndrome: paraesthesiae in limbs on neck flexion motor symptoms - spastic weakness (most commonly in legs) cerebellar symptoms - ataxia - tremor others symptoms - urinary incontinence - sexual dysfunction - intellectual deterioration

Answer 36

subtype of Guillain-Barré syndrome (GBS) characterised by areflexia, ataxia and ophthalmoplegia descending weakness is a classic features as opposed to ascending weakness in more common forms of GBS anti-GQ1b antibodies present in most cases

Answer 37

aka central pontine myelinolysis - can occur due to overcorrection of severe hyponatraemia - Na levels should only be raised by 4-6 mmol/l in 24h symptoms usually occur after 2 days and are irreversible - dysarthria - dysphagia - paraparesis or quadriparesis - seizures - confusion - coma patients are awake but unable to move or verbally communicate - locked-in syndrome from high to low your brain will blow - cerebral oedema from low to high your pons will die - central pontine myelinolysis

Answer 38

- Relapsing remitting Multiple Sclerosis (RRMS) > Unpredictable attacks which may or may not leave permanent deficits followed by periods of remission - Primary progressive multiple sclerosis (PPMS) > At least 1 year of disease progression > Steady increase in disability without attacks - Secondary progressive multiple sclerosis (SPMS) > Initial relapsing-remitting multiple sclerosis > Suddenly begins to decline without periods of remission - Benign multiple sclerosis (BMS)

Answer 39

- disease-modifying therapies e.g. natalizumab for RRMS or ocrelizumab for PPMS - relapses: high dose steroids e.g. IV methylprednisolone - symptomatic > strength: exercise > fatigue: amantadine, modafinil, SSRIs > neuropathic pain: amitriptyline, gabapentin > depression: SSRIs > urge incontinence: solifenacin > spasticity: baclofen, gabapentin > oscillopsia: gabapentin, memantine

Answer 40

diagnosis is clinical - features > asymmetric limb weakness > mixture of LMN and UMN signs > wasting of small hand muscles / tibialis anterior > fasciculations > emotional lability > absence of sensory signs/symptoms > sparing of eye movements > nerve conduction studies: normal motor conduction, exclude neuropathy > electromyography: reduced number of action potentials with increased amplitude > MRI - exclude cervical cord compression and myelopathy usually pathological TDP-43 proteins

Answer 41

- amyotrophic lateral sclerosis (ALS) > most common - progressive bulbar palsy > second most common > affects talking/swallowing > causes tongue wasting and fasciculations - progressive muscular atrophy - primary lateral sclerosis management - riluzole: slow progression of disease - symptomatic > spasticity: baclofen > antimuscarinics: excessive salivation > NIV to support breathing - advanced directives, end-of-life care

Answer 42

usually a paraneoplastic syndrome occurring alongside small-cell lung cancer (SCLC) > can occur as a primary autoimmune disorder caused by antibodies against voltage-gated calcium channels clinical features - proximal muscle weakness (difficulty climbing stairs/rising from chair) - autonomic dysfunction (dry mouth, blurred vision, impotence, dizziness) - reduced / absent tendon reflexes symptoms IMPROVE after periods of muscle contraction, as opposed to myasthenia gravis (fatiguability) management - exclude malignancy - amifampridine: voltage-gated potassium channel blocker - pyridostigmine, immunosuppressants - IV immunoglobulins, plasmapheresis

Answer 43

aka Huntington's chorea AD trinucleotide repeat disorder > demonstrates anticipation: successive generations have earlier age of onset / increased severity of disease clinical features - chorea: involuntary, random, irregular and abnormal body movements - dystonia: abnormal muscle tone leading to abnormal postures - rigidity - eye movement disorders - dysarthria, dysphagia - cognitive, psychiatric or mood problems investigations > genetic testing > MRI: caudate atrophy management - genetic counselling - SSRIs if depressed - tetrabenazine for chorea - supportive: physio, SALT, advanced directives, end-of-life care

Answer 44

AD condition cutaneous features - depigmented ash-leaf spots which fluoresce under UV light - roughened patches of skin over lumbar spine (Shagreen patches) - adenoma sebaceum (angiofibromas): butterfly distribution over nose - subungal fibromata - cafe-au-lait spots may be seen - angiomyolipomas neuro features - developmental delay - epilepsy (infantile spasms or partial) - intellectual impairment also: retinal hamartomas, rhabdomyomas of the heart, gliomatous changes in brain lesions, polycystic kidneys, lymphangioleiomyomatosis

Answer 45

2 types: neurofibromatosis type 1 is more common > NF2 is associated with BILATERAL acoustic neuromas AD inheritance clinical features: CRABBING - cafe au lait spots - relative with NF1 - axillary or inguinal freckling - bony dysplasia e.g. bowing of a long bone - iris hamartomas (Lisch nodules) - neurofibromas: skin-coloured raised nodules - glioma of optic pathway management: monitor for complications complications - migraines - epilepsy - renal artery stenosis - multiple tumours (e.g. spinal cord, GIST...) - vision loss due to optic nerve glioma

Answer 46

clinical features - body stiff, rigid, crashes to the ground - from rigid to rhythmical jerking (not tremor) - may have urinary incontinence / lateral tongue biting - cyanotic - eyes often open (rolled back) usually last 1-2 minutes post-seizure - non-responsive - heavy breathing/snoring - post-ictal confusion - patient may: not remember events, have headache, myalgia, and go to sleep it off

Answer 47

generalised - tonic - clonic - atonic - tonic-clonic - myoclonic - absence focal - depends on origin of seizure - +/- impaired consciousness - +/- becoming generalised

Answer 48

Low CSF headaches caused by spontaneous intracranial hypotension > worse on standing, improved lying flat more common in connective tissue disorder e.g. Marfan's syndrome Conservative management. Epidural blood patch if this fails.

Answer 49

Trigeminal neuralgia: pain syndrome characterised by severe unilateral pain in trigeminal distribution > brief electric shock-like pains, abrupt in onset and termination with a refractory period triggers > light touch, washing, shaving, smoking, talking, and brushing the teeth (trigger factors), and frequently occurs spontaneously idiopathic but compression of trigeminal roots by tumours or vascular problems may occur Management - carbamazepine is first-line - failure to respond to treatment or atypical features (e.g. < 50 years old) should prompt referral to neurology > surgery: microvascular decompression

Answer 50

Rapidly progressive neurodegenerative prion disorder, usually sporadic but can be inherited clinical features - rapid cognitive decline - myoclonic jerks - behavioural change - visual disturbance - ataxia Key investigations - MRI - lumbar puncture - EEG > bi- or tri-phasic periodic sharp wave complexes appearing with a frequency of around 1-2 per second. Definitive diagnosis: post-mortem biopsy

Answer 51

- ROSIER score: asymmetric weakness, speech disturbance, visual disturbance - Non-contrast CT head: > acute ischaemic strokes >> areas of low density in the grey and white matter; changes may take time to develop >> other signs include the 'hyperdense artery' sign corresponding with the responsible arterial clot - this tends to visible immediately > acute haemorrhagic strokes >>hyperdense material (blood) surrounded by low density (oedema)

Answer 52

sequelae of chronic repeated head injury usually in athletes e.g. rugby / boxing clinical features - behavioural change - cognitive difficulties - mood disturbance

Answer 53

Rise in serum prolactin can help to differentiate a seizure from a pseudoseizure pseudoseizures also tend to have a gradual onset while true seizures have sudden onset Other features suggestive of seizure > Tongue biting > Urinary incontinence > Post-ictal phase > Memory loss > Todd's paresis (post-ictal weakness)

Answer 54

caused by rupture of bridging veins risk factors: elderly, alcoholism, anticoagulation Clinical presentation - fluctuating consciousness - altered mental state - focal neurology - falls - can be triggered by alcohol excess management - acute subdural haematoma: neurosurgical referral for evacuation of haematoma e.g. decompressive craniectomy - chronic subdural haematoma: > asymptomatic: conservative > symptomatic: burr hole drainage

Answer 55

AR disorder characterised by excessive copper deposition in tissues Features - Liver: hepatitis, cirrhosis - Neurological: speech, behavioural and psychiatric problems - Kayser-Fleischer rings: green-brown rings in the periphery of the iris - Renal tubular acidosis - Haemolysis - Blue nails Lab - Reduced serum caeruloplasmin - Reduced total serum copper - Increased 24h urinary copper excretion Management - penicillamine (chelates copper)

Answer 56

pathophysiology > mostly trauma, low-impact head injury > especially over temporal region due to the pterion overlying the middle meningeal artery patients may experience a lucid interval > briefly regain consciousness after injury before progressing into coma imaging - biconvex or lentiform hyperdense collection limited by suture lines of skull management - no neurological deficit: cautious clinical and radiological observation - definitive treatment: craniotomy and evacuation of haematoma

Answer 57

acute, unilateral, idiopathic, facial nerve paralysis. risk factors - age 20-40 years - pregnant women Features > lower motor neuron facial nerve palsy → forehead affected > post-auricular pain (may precede paralysis) > altered taste > dry eyes > hyperacusis Management - oral prednisolone within 72 hours of onset of Bell's palsy - eye care to prevent exposure keratopathy: prescribe artificial tears and eye lubricants, taping at night

Answer 58

due to development of syrinx (CSF-filled cyst) in the anterior white commisure of the spinal cord Presentation - cape-like loss of pain and temperature sensation due to compression of spinothalamic tract fibres decussating in centre of spinal cord - preserved light touch, proprioception and vibration - spastic weakness - neuropathic pain - upgoing plantars - autonomic features > Horner's syndrome due to compression of sympathetic chain > scoliosis can develop if untreated causes - congenital e.g. Arnold-Chiari malformation - acquired: trauma e.g haemorrhage, tumour - idiopathic investigations - full spine MRI with contrast - exclude tumour / tethered cord - brain MRI - exclude Chiari malformation Treatment - manage underlying cause - shunt into syrinx

Answer 59

causes - extension of sepsis from middle ear or sinuses - trauma or surgery to the scalp - penetrating head injuries - embolic events from endocarditis clinical features - depends on the site of the abscess - headache (dull, persistent) - fever - focal neurology e.g. oculomotor nerve palsy - other features of raised ICP: nausea, papilloedema, seizures investigations - CT head management - surgery > craniotomy and debridement of abscess cavity - IV Abx: IV 3rd generation cephalosporin + metronidazole - Intracranial pressure management: e.g. dexamethasone

Answer 60

abnormal breathing pattern characterised by periods of hyperventilation alternating with apnoea occurs due to compression of brainstem

Answer 61

typically affects teenage girls - infrequent generalised seizures often in the morning / following sleep deprivation - daytime absences - sudden shock-like myoclonic seizure

Answer 62

- stop antiplatelets / anticoagulants - control BP (target 140 mmHg)

Answer 63

usually caused by cavernous sinus tumours features - pain - ophthalmoplegia - proptosis - trigeminal nerve lesion (ophthalmic branch) - Horner's syndrome

Answer 64

presentation - pain (neck, upper or lower limbs) - loss of motor function (loss of digital dexterity, arm or leg weakness/stiffness leading to impaired gait and balance) - loss of sensory function causing numbness - loss of autonomic function (urinary or faecal incontinence / impotence) - Hoffman's sign: exaggerated flexion of terminal phalanx of thumb after flicking DIP joint of middle finger > UMN sign MRI - gold standard management - urgent referral for assessment by specialist spinal services - decompressive surgery

Answer 65

can start driving if symptom free after 1 month - no need to inform DVLA

Answer 66

clinical features - headache - vomiting - neck stiffness - visual field defects: bitemporal superior quadrantic defect - extraocular nerve palsies - features of pituitary insufficiency > hypotension, hyponatraemia secondary to hypoadrenalism investigation: MRI management - urgent steroids due to loss of ACTH - careful fluid balance - surgery