Neurology Crash Course

Question 1

What is the most appropriate management?

Answer 1

IV phenytoin

Question 2

Status epilepticus

Answer 2

Convulsive seizure lasting >5mins recurring seizures without recovery

Question 3

Status epilepticus management

Answer 3

Question 4

What management?

Answer 4

Urgent CT head

Question 5

Stroke - classification

Answer 5

Question 6

Stroke management

Answer 6

Face
Arm
Speech
Time
HASU - hyperacute stroke unit
CT head within an hour
If bleed - neurosurgical opinion, BP control and monitoring 
If ischaemic - within window? 4.5 hours? Thrombolysis/thrombectomy (slightly longer time) + aspirin 300mg

Question 7

Most likely diagnosis?

Answer 7

Charcot Marie tooth

Question 8

Charcot Marie tooth

Answer 8

Collection of hereditary peripheral neuropathies due to an inherited mutation
Multiple subtypes with different mutations
Slowly progressive, distal calf atrophy, pes cavus, clumsy walking, weakness, sensation reduced + positive fH

Question 9

Peripheral neuropathy - polyneuropathy

Answer 9

Question 10

Answer 10

Question 11

L46 SO4 E3

EYE MOVEMENTS

Answer 11

Question 12

What is the cause?

Answer 12

3rd nerve palsy

Usually eye down and out, usually ptosis also

Question 13

Third nerve palsy

Answer 13

Oculo-motor nerve damage
Innervates the eyelid, extra-ocular muscle and pupil
Damage anywhere leads to a down and out eye with or without pupillary dilatation
Concerning for cerebral aneurysm

Question 14

DOT - dilated pupil

Answer 14

Question 15

HAM - constricted pupil

Answer 15

Question 16

Dilated vs constricted pupil

Answer 16

Question 17

MRI spine - suspected inflammatory lesion in the lower thoracic spine
No compression or vascular abnormality
Imaging of the brain shows multiple areas of demyelination
LP - oligoclonal band +

Most likely diagnosis?

Answer 17

Multiple sclerosis

Question 18

MS

Answer 18

Chronic autoimmune condition characterised by demyelination
Immune-mediated inflammatory disease, which affects the CNS
Can affect multiple sites
Typically a relapsing/remitting pattern
Aided by MRI

Question 19

Myelopathy

Answer 19

Question 20

MS treatment

Answer 20

IV methylprednisolone

Question 21

Managing MS

Answer 21

Question 22

Acute headache treatment?

Answer 22

Sumatriptan

Question 23

Topiramate and propranolol help to…

Answer 23

Prevent headache

Question 24

Migraine

Answer 24

Question 25

Headache red flags

Answer 25

Worse on lying, sudden/severe, worse on standing, recent trauma, fever, meningism, previous malignancy, papilloedema

Question 26

Headache overview

Answer 26

Question 27

20/30 MOCA
CT head - diffuse cerebral atrophy, mild burden of small vessel disease but no mass/infarct/bleeding
Most likely cause of cognitive impairment?

Answer 27

Based on history - HTN and vascular disease
Predominant memory loss, no previous stroke and low burden
Alzheimer’s likely

Question 28

Dementia overview

Answer 28

ADLs affected

Alzheimer’s most common for dementia

Question 29

Dementia aetiology overview

Answer 29

Question 30

Most important info to give to the patient?

Answer 30

The drug may cause impulse control disorder

Question 31

Parkinson’s

Answer 31

Loss of dopaminergic neurones within the substantia nitrates
Characterised by Parkinsonism (Bradykinesia, resting tremor, rigidity, postural instability)
Boost dopamine levels

Question 32

Parkinson’s treatment overview

Answer 32

Question 33

Impulse control disorder with dopamine agonists

Answer 33