syndrome and arteries

Question 1

what is wallenberg syndrome

Answer 1

This patient presents with a Horner’s syndrome on examination as well as possible signs of vertigo, ataxia and dysphagia. This should raise suspicion of Wallenberg syndrome (also known as lateral medullary syndrome), usually from an infarction of the posterior inferior cerebellar artery (PICA). The presentation can be summarised by the mnemonic “DANVAH” - Dysphagia, ipsilateral Ataxia, ipsilateral Nystagmus, Vertigo, Anaesthesia (Ipsilateral facial numbness and contralateral pain loss on the body) and ipsilateral Horner’s syndrome

Question 2

pencillamine can cause what

Answer 2

There is a significant risk of causing drug-induced lupus or myasthenia gravis with Penicillamine treatment.

Question 3

A 65 year old woman presents to her GP complaining of double vision.

On examination her right eye retains a full range of movement, but the left eye is depressed and laterally deviated. The pupils are equal and reactive to light, visual testing is within normal limits, and her cranial nerves are otherwise normal.

Systemic examination reveals a BMI of 38, but no evidence of cardiovascular disease. Neurologically there is glove and stocking sensory neuropathy to the mid shins, and evidence of a left sided foot drop.

Her past medical history includes poorly controlled type 2 diabetes mellitus, hypertension, familial hypercholesterolaemia and a wide local excision for early-stage breast cancer 5 years previously.

What is the single most likely explanation for this patient’s symptoms?

Answer 3

Mononeuritis multiplex

The combination of a pupil-sparing third nerve palsy, associated with foot drop (likely due to a common peroneal nerve palsy) in the context of poorly controlled diabetes mellitus are highly suggestive of diabetic mononeuritis multiplex

Question 4

what stroke is a diffusion weighed MRI scan good for

CT for other

Answer 4

This is the correct answer. This woman has had a thromboembolic stroke affecting her right middle cerebral artery, secondary to a thrombus in her left atrial appendage. This is a known complication of atrial fibrillation.

CT scans are useful for detecting haemorrhagic strokes, but can be normal in the first few hours of an ischaemic stroke. Diffusion-weighted MRI can confirm early ischaemic stroke, which appears bright

Question 5

perseveration

Answer 5

This describes the repetition of gestures, words or phrases, in the absence of a stimulus. This is typically associated with brain injuries

Question 6

automatisms

Answer 6

Automatisms typically involve stereotyped behaviours during seizures such as smacking one’s lips