Neurology

Question 1

Bell’s Palsy

Answer 1

• facial nerve palsy
• sudden unilateral facial weakness that also affects the eyebrows, numbness or pain around the ear, reduced taste, hypersensitivity to sounds, failure of eye closure causes watery eye
• Other causes: MS, stroke, ramsay hunt syndrome
• Tests: esr, glucose,
• Rx- prednisolone
• Advice: protect the eye by closing with tape at night, artifical tears, dark glasses, regular eyelid closure with hand

Question 2

Mononeuropathies

Answer 2

Foot drop (L4-S1) - common peroneal nerve palsy, after prolonged knee flexion, sensory loss over dorsum of foot, management with footdrop splint 
Wrist drop (C5-T1) - radial nerve palsy, wrisy and finger drop, sensory loss over anatomical snuff box, manage with wrist drop splint

Question 3

Ramsay Hunt syndrome

Answer 3

• Complication of shingles affecting the facial nerve
• Symptoms: Rash of blisters around ear or scalp, weakness on affected side, altered taste, hearing loss, dizziness/ vertigo, tinnitus
• Treatment: Aciclovir within 3 days

Question 4

Headache history differentials

Answer 4

• Cluster headache
• Tension headache
• Migraine
• Meningitis/ Encephalitis
• Temporal arteritis
• Acute glaucoma
• SOL/ Tumour
• Hemorrhage
• Temporal neuralgia

Question 5

Weakness history differentials

Answer 5

• Stroke
• Tia
• MS
• Polyneuropathy
• Mononeuropathy
• Transverse myelitis

Question 6

Causes of cervical cord syndromes

Answer 6

• MS, NMO, Devic’s, Autoimmune diseases, VZV, HIV, B12 deficiency, copper deficiency

Question 7

Management of Status epilepticus

Answer 7

1. First line = IV lorazepam 4mg or Buccal midazolam 10 mg (every 5 min for first 20 mins)
2. > 20 mins, IV phenytoin or IV valproate or IV levetirazcetam
3. > 40 mins, ICU and ventilation, IV propofol or IV thiopentone