Neurology MCQ Flashcards by Ahmed Sagheir

how to differentiate between secondary and primary generalized seizures

secondary generalized seizure = focal to bilateral tonic-clonic seizure

on the basis of other evidence that supports a focal epilepsy/etiology, or there may be asymmetry seen in the focal to bilateral tonic-clonic seizure (such as head/eye version to one side, asymmetric amplitude to the motor features), and this asymmetry is seen consistently from seizure to seizure.

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patient is able to identify that fear is the primary onset feature of the seizure, and results in immobility, what is the type of seizure

focal emotional seizure with fear

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somatosensory seizures originate from

Postcentral gyrus of parietal lobe

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motor seizures originate from

Precentral gyrus of Parietal lobe

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Visceral and autonomic seizures originate from

Insula
cingulate gyrus
frontal temporal areas

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Gustatory seizure originates from

Parietal areal
insula

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Olfactory seizure originates from

mesial temporal or orbitofrontal regions

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what is the duration of tonic seizures

3 seconds ~ 2 minutes

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how to differentiate between clonic seizures and repetitive serial
myoclonic seizures

rhythmicity of the jerking
Loss of consciousness

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duration of epileptic spasms

1 ~ 2 seconds

Longer than Myoclonic jerk
shorter than Tonic seizure

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The peak age at onset of infantile spasms is

3 - 8 Months

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what is criteria of epilepsy

> 2 unprovoked seizures occurring >24 hours apart

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which abnormal lab is most commonly associated with seizures

Glucose abnormalities
Hyponatremia

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what is the most common cause of seizures in childhood

Febrile seizures

occurring in 2 to 5% of children between the ages of 6 months and 6 years
with a temperature of 38°C or higher

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what is the peak age of febrile seizures

12 ~ 18 months

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what is the investigation of choice in epilepsy

MRI

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choice of drug in Epilepsy depends on

Seizure type

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in drug therapy of epilepsy, If control is poor on the first drug at the highest tolerated dose, what is the next step?

treatment should be then changed to
monotherapy with another first line drug

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if treatment with another first line drug failed

treat with a maximum of two anti convulsants

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when to stop AED

after 2 years seizure-free

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AED of choice in Generalized tonic–clonic

Sodium valproate
Lamotrigine
Levetiracetam

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AED of choice in Tonic or Atonic

Sodium valproate

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AED of choice in Absence

ethosuximide

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AED of choice in Myoclonic

Sodium valproate

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AED of choice in **Focal**

Lamotrigine

in Status epilepticus, t1 refers to

Time when a seizure is likely to be prolonged leading to continuous seizure activity (or time to start ttt) ## Footnote Tonic - clonic SE = 5 min Focal SE with impaired consciousness = 10 min

in Status epilepticus, t2 refers to

Time when a seizure may cause long term consequences (including neuronal injury, neuronal death, alteration of neuronal networks and functional deficits) ## Footnote Tonic - clonic SE = 30 min Focal SE with impaired consciousness = 60 min

most common cause of status epilepticus

de novo due to acute cerebral disturbances

Age of CP affection

up to 3 years

what is the immediate effect of asphyxia

hypoxic ischemic encephalopathy

what is the immediate effect of kernicterus

1. lethargy 2. ↑ muscle tone 3. decreased Moro sign 4. opisthotonus

what is the delayed effect of kernicterus

1. Choreoathetoid CP 2. Sensorineural deafness

which area of the brain is affected in Spastic type CP

Motor area 4

which area of the brain is affected in ataxic CP

Cerebellum

which area of the brain is affected in Extrapyramidal type

Basal ganglia

which type of Cerebral palsy is commonly associated with epilepsy

Spastic Quadriplegic CP ## Footnote then spastic hemiplegic

what is rapid bed side test for coma

Blood glucose

signs of meningeal inflammation in infants

irritability, restlessness, depressed mental status, and poor feeding ## Footnote Babinski and kernig is for children over 12 months

Normal rate of CSF production

0.3 ~ 0.5 ml/min = 20 ml/h

Normal CSF volume

50 ml in infants 150 ml in Adults

Most of CSF is ......

Extra ventricular

Most common cause on congenital Hydrocephalus is

Aqueductal stenosis ## Footnote XLR - Spina bifida occulta

congenital infection associated with Congenital Hydrocephalus

Toxoplasma

patient with congenital infection developed Periventricular calcifications

CMV

patient with congenital infection developed scattered calcifications and choreoretinitis

Toxoplasma

Why to auscaltate head of patient in Hydrocephalus

to detect Bruit → A-V malformation of Great cerebral vein of Galen

most common place for Meningeocele

Lumbosacral area

what is the preferred treatment for Hydrocephalus

Surgical

most common shunt used in hydrocephalus

ventriculoperitoneal (spitz holter)

disadvantage of Ventriculoarterial shunt

arrythmia & Volume overload

what is the second line surgical approach for Hydrocephalus

Ventriculopleural shunt

Using CT, how to differentiate between compensated & non compensated Hydrocephalus

by transependymal CSF permeation in the periventricular white matter

what is the most common cause of death in CP

Aspiration pneumonia & infections

in Transverse myelitis, UMNL manifestations appear after

3 ~ 6 weeks

value of MRI in transverse myelitis

Exclude Autoimmune encephalitis and spinal cord compression

muscle weakness distribution in myopathy vs neuropathy

Myopathy → Proximal > distal Neuropathy Distal > proximal

cause of death in SMA I

bronchopneumonia and respiratory failure

what are the onsets for SMA

1. SMA I → 2~6 months (starts IU / 1st 24h) 2. SMA II → 6 ~ 18 months 3. SMA III → >18 months 4. SMA IV → Adult onset

what is the mainstay treatment for Guilian Barre $

Plasmapheresis/Intravenous Immunoglobulin

Regarding congenital myopathies, the definitive diagnosis of each type is determine by

histopathological finding in muscle biopsy

how to differentiate between Congenital myopathy and muscular dystrophy

**Congenital myopathy** → Earlier, static, Normal CK, Mutations in Protein / Enzymes **Muscle Dystrophy** → Later, Progressive, ↑↑ CK, Mutations in cell membrane

mode of inheritance in DMD

XLR

how to differentiate between bulbar and pseudo bulbar palsy

Bulbar → uvula deviated to the normal site and absent Gag reflex

most common cause of CP

1. Meningitis 2. head injury

most common form of cp

spastic ## Footnote two of the following : Abnormal movement pattern - ↑ Tone - abnormal reflexes

a child with ↑ bilirubin develops which type of CP

choreoathetoid

arousal depends on

communication between the ascending reticular activating system (ARAS) which is located in the brain stem and its targets in the hypothalamus, thalamus, and cerebral cortex

Awareness depends on

connections between cortical and subcortical structures; cerebral hemispheres

absent doll's eye response indicates

brainstem dysfunction

most common organisms causing meningitis

1. Strept. pneumoniae 2. H. Influenza 3. Neisseria Meningitidis ## Footnote 1 & 3 → Rapid onset

MOT of bacterial meningitis

1. Droplet of RT / throat secretion → hematogenous spread to BBB 2. direct inoculation from penetrating head injury

most common organism causing brain abscess

Streptococcus anginosus 2nd → Staph aureus

mode of inheritance in SMA