Which of the following is least associated with Parkinsonism?
Correct Answer D:
Parkinsonism:
Causes of Parkinsonism:
Drugs causing Parkinsonism:
Domperidone does not cross the blood-brain barrier and therefore does not cause extra-pyramidal side-effects.
You review a 70-year-old woman four days after she was admitted with a suspected stroke. Unfortunately she has been left with right sided sensory loss affecting her arms more than the legs and a right sided homonymous hemianopia. Functionally she has difficulty dressing her self. Examination of her cranial nerves is unremarkable.
What area is the stroke most likely to have affected?
Correct Answer A:
Stroke by anatomy:
Anterior cerebral artery:
Middle cerebral artery:
Posterior cerebral artery:
Lacunar:
Pontine:
A 28-year-old woman with a history of systemic lupus erythematosus (SLE) presents with jerky, irregular movements which seem to move from one limb to another. Her symptoms are continuous and there are no other neurological features such as impairment of consciousness.
Where is the neurological lesion most likely to be?
Correct Answer E: Chorea is caused by damage to the basal ganglia, in particular the Caudate nucleus.
These symptoms are consistent with chorea, which may have a number of causes including SLE. Temporal lobe epilepsy would not cause continuous symptoms.
Chorea:
Chorea describes involuntary, rapid, jerky movements which often move from one part of the body to another.
Slower, sinuous movement of the limbs is termed athetosis. Chorea is caused by damage to the basal ganglia, especially the caudate nucleus.
Causes of chorea:
Which one of the following antibodies are associated with painful sensory neuropathy in patients with small cell lung cancer?
Paraneoplastic syndromes affecting nervous system:
Lambert-Eaton myasthenic syndrome:
Anti-Hu:
Anti-Yo:
Anti-GAD antibody:
Anti-Ri:
A 68-year-old woman presents with a two month history of electric shock like pains on the right side of her face. She describes having around 10-20 episodes a day which, each lasting for around 30-60 seconds. A recent dental check was normal. Neurological examination is unremarkable.
What is the most suitable first-line management?
Correct Answer C: Trigeminal neuralgia - carbamazepine is first-line.
Trigeminal neuralgia:
Trigeminal neuralgia is a pain syndrome characterized by severe unilateral pain. The vast majority of cases are idiopathic but compression of the trigeminal roots by tumours or vascular problems may occur.
The International Headache Society defines trigeminal neuralgia as:
Management:
*The 2010 NICE neuropathic pain guidelines recommend using amitriptyline or pregabalin first-line for nondiabetic neuropathic pain., but makes no specific recommendation for trigeminal neuralgia. Due to the amount of evidence supporting carbamazepine in trigeminal neuralgia and its recommendation in consensus guidelines (including Clinical Knowledge Summaries) the author does not feel that this recommendation should be changed for now.
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