Neurology

Question 1

Treatment options for generalised dystonia / cervical dystonia? (4)

Answer 1

1. Levodopa
2. Anticholinergics
3. BOTOX injection
4. Deep brain stimulation

Question 2

Problems with Deep brain stimulation for cervical dystonia?

Answer 2

Pre-op: needs GA, as it requires creating a Burrhole to implant the leads. Risk of bleeding and stroke, infection.

Post-op: device failure. Also some can get lightheadedness, tingling, speech, balance problems or new involuntary movements.

Question 3

Investigation for unilateral lower limb weakness?

Answer 3

Take a systemic approach.

I’d examine the patient if the patterns consistent with UMN vs LMN.

LMN:

Muscle: proximal myopathy, myositis

NMJ: myasthenia gravis, Eaton-Lambert

Peripheral nerve palsy: *** diabetes, hypothyroidism, acromegaly, compression, trauma (#/dislocation), infection. Mononeuritis multiplex - vasculitis, paraneoplastic, infection, infiltrative.

Plexopathy: vast dermatomal sensory loss. Tumour, trauma, compression, infection.

Radiculopathy (nerve root): dermatological sensory loss. Compression (disc, osteophytes, spinal stenosis), tumour, trauma, infection

UMN:

Spinal cord problems: SOL, MS, infection, abscess, infarct/bleeding/AVM

Brain stem / Cranial: stroke, SOL, MS