A 29-year-old female presents complaining of double vision and unsteadiness. She has no past medical history of note. On examination she has limited movement of her eyes in all directions. Pupils are 3 mm, equal and reactive to light. Examination of the peripheral nervous system is normal other than reduced reflexes and the plantars are down going. Some past-pointing is also noted.
What is the most likely diagnosis?
Correct Answer C: Miller Fisher syndrome - areflexia, ataxia, ophthalmoplegia.
This patient has Miller Fisher syndrome, a variant of Guillain-Barre syndrome.
Guillain-Barre syndrome:
Guillain-Barre syndrome describes an immune mediated demyelination of the peripheral nervous system often triggered by an infection (classically Campylobacter jejuni).
Pathogenesis:
Miller Fisher syndrome:
In the treatment of migraine, sumatriptan is an example of a:
Correct Answer C:
Migraine: management: It should be noted that as a general rule 5-HT receptor agonists are used in the acute treatment of migraine whilst 5-HT receptor antagonists are used in prophylaxis. NICE produced guidelines in 2012 on the management of headache, including migraines.
Acute treatment:
Prophylaxis:
*Caution should be exercised with young patients as acute dystonic reactions may develop.
A 34-year-old female is reviewed in the neurology clinic due to a number of 'funny-dos'. She describes a sensation that her surroundings are unreal, 'like a dream'. Following this she has been told that she starts to smack her lips, although she has no recollection of doing this.
Correct Answer C: With simple partial seizures there is no disturbance of consciousness or awareness. Lip smacking is an example of an automatism - an automatic, repetitive act.
Epilepsy: classification:
Basics:
Generalized - no focal features, consciousness lost immediately:
Partial - focal features depending on location:
Myoclonus:
A 25-year-old female presents 5 days after discharge from hospital following an admission for suspected meningitis. A lumbar puncture was performed which showed no evidence of infection. Unfortunately she developed a headache 48 hours after discharge. This has now lasted 3 days and has failed to settle with analgesia.
Which one of the following treatment options should be considered?
Correct Answer D:
Post-lumbar puncture headache:
Headache following lumbar puncture (LP) occurs in approximately one-third of patients. The pathophysiology of is unclear but may relate to a 'leak' of CSF following dural puncture. Post-LP headaches are more common in young females with a low body mass index.
Typical features:
Management:
A 62-year-old man presents with left-sided eye pain and diplopia for the past 2 days. Examination of his eyes shows his pupils equal and reactive to light with no proptosis. There is however an apparent palsy of the 6th cranial nerve associated with a partial 3rd nerve palsy on the left side. Examining the remaining cranial demonstrates hyperaesthesia of the upper face on the left side.
Where is the likely lesion?
Correct Answer A:
Intracranial venous thrombosis:
Overview:
Features:
Sagittal sinus thrombosis:
Cavernous sinus thrombosis:
Lateral sinus thrombosis:
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