Neurology

Question 1

A man has progressive, fluctuant cognitive decline, parkinsonism, associated with visual hallucinations. Diagnosis?

Answer 1

Visual hallucinations with dementia = Lewy body dementia
clumps of proteins being deposited within neurons, can also feature rapid eye movement sleep disorders, parkinsonism, and marked dysautonomia. There is early development of higher-order functioning, such as planning and organisation,

Question 2

Diagnosis of Lewy body dementia??

Answer 2

-Usually clinical
-Single-photon emission computed tomography (SPECT) is increasingly used. It is currently commercially known as a DaTscan. Dopaminergic iodine-123-radiolabelled 2-carbomethoxy-3-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (123-I FP-CIT) is used as the radioisotope. The sensitivity of SPECT in diagnosing Lewy body dementia is around 90% with a specificity of 100%

Question 3

How to treat Lewy body dementia?

Answer 3

-Both acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine) and memantine
-AVOID neuroleptics as patients are extremely sensitive and can develop irreversible parkinsonism.
{Questions may give a history of a patient who has deteriorated following the introduction of an antipsychotic agent}

Question 4

What are the causes and risk factors for developing carpal tunnel syndrome?

Answer 4

-Repetitive stress (Typing)
-Obesity
-Pregnancy
-Idiopathic
-Edema eg Heart Failure
-Lunate fracture
-RA

Question 5

How to make diagnosis of CTS??

Answer 5

-Electrophysiological testing:
-Symptoms
-Physical testing:
–Phalens test: Numbness/paresthesia on flexion of wrist for 1 min
–Tunel test: Numbness/paresthesia on tapping the median nerve at wrist
–DURKAN’s test: Numbness/paresthesia on manually compressing the transverse carpal ligament for 30sec.

Question 6

How to manage CTS?

Answer 6

6 wks trial of:
-Behavior modification
-CS injection
-Wrist splints at night esp if pregnant

Surgical decompression by flexor retinaculum/transverse carpal ligament division

Question 7

Features of optic neuritis??

Answer 7

-Unilateral decrease in visual acuity over hours or days
-Poor discrimination of colours, ‘red desaturation’
-Pain worse on eye movement
-Relative afferent pupillary defect
-Central scotoma
(NOT Sudden vision loss)