Revision

Question 1

Autoantibodies in Neurology

Answer 1

Myasthenia Gravis

• ACHR antibody: correlate with thymoma or thymic hyperplasia
• MuSK Ab: not related to thymoma or thymic hyperplasia, normally early onset of disease

Lambert Eaton Myasthenic Syndrome
- Voltage gated calcium channel antibody

GBS and Variants

• Acute Motor Axonal Neuropathy (motor predominant): anti- GM1, anti- GD1a
• Miller Fisher (ataxia, ophthalmoplegia, areflexia): anti-GQ1

Neuromyelitis Optica Spectrum Disorder

• Aquaporin 4 Ab
• MOG Ab (50% of all AQP4 –ve cases)

IgM MGUS
- Anti-MAG Ab

Question 2

Difference between cauda equina vs spinal cord syndrome

Answer 2

Spinal Cord Syndrome

• MSCC (metastatic or malignant spinal cord compression) is where a cancer or metastasis presses on and subsequently compresses the spinal cord.
• Compression can also occur due to compromise of spinal stability due to vertebral metastases and compression from associated fractures.

Cauda Equina Syndrome

• Cauda equina syndrome is the same process but occurring at or below the level of the cauda equina (typically at the level of L1)
• Usually affects small nerve fibres first, ie autonomic nerves
• Symptoms result from compression of nerve roots
• Both usually presents with pain and weakness and should be treated the same way
• Cord compression causes an UPPER MOTOR NEURON (UMN) pattern of weakness
• Cauda equina causes an LOWER MOTOR NEURON (LMN) pattern

Question 3

On which chromosome does the most common mutation responsible for hereditary strokes reside on?

a) 21
b) B-3
c) C - 19
d) D-X

Answer 3

c) C - 19

CADASIL
CADASIL or CADASIL syndrome, involving cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, is the most common form of hereditary stroke disorder, and is thought to be caused by mutations of the Notch 3 gene on chromosome 19.

Question 4

Which of the following pathologies is NOT a possible cause for a Horner’s syndrome?
A- Apical lung tumour
B- Dissection of the external carotid artery
C- High cervical cord syrinx
D- Lateral medullary ischaemic stroke

Answer 4

B- Dissection of the external carotid artery

Answer B: Dissection of the internal carotid artery is a common cause of a Horner’s syndrome

Question 5

Which of the following statements regarding the cerebellopontine angle is FALSE?
A - The most common tumour found in this location is associated with Neurofibromatosis Type 2
B - The principle vessel in this area is the posterior inferior cerebellar artery
C – It is a CSF filled cistern
D - Tumours in this location may cause ipsilateral deficits in cranial nerves V and VII

Answer 5

Answer B:

The principle vessel in this area is the AICA (anterior inferior cerebellar artery)