How long should a patient stop driving for following a stroke?
Correct Answer B: DVLA advice post CVA: cannot drive for 1 month.
DVLA: neurological disorders:
The guidelines below relate to car/motorcycle use unless specifically stated. For obvious reasons, the rules relating to drivers of heavy goods vehicles tend to be much stricter.
Specific rules:
Syncope:
*Previously rule was 12 months. It is now 6 months off driving if the license holder has undergone assessment by an appropriate specialist and no relevant abnormality has been identified on investigation, for example EEG and brain scan where indicated.
**If the tumour is a benign meningioma and there is no seizure history, license can be reconsidered 6 months after surgery if remains seizure free.
A 60-year-old man is diagnosed with Bell's palsy. What is the current evidence based approach to the management of this condition?
Correct Answer E:
Bell's palsy:
Bell's palsy may be defined as an acute, unilateral, idiopathic, facial nerve paralysis. The aetiology is unknown although the role of the herpes simplex virus has been investigated previously.
Features:
Management:
Prognosis:
*Upper motor neuron lesion 'spares' upper face
Which one of the following is most associated with a good prognosis in Guillain-Barre syndrome?
Correct Answer C: Preceding gastrointestinal infections are associated with a poor prognosis in Guillain-Barre syndrome. The sex of the patient has not been shown to correlate with outcome.
Guillain-Barre syndrome: prognosis:
Guillain-Barre syndrome (GBS) describes an immune mediated demyelination of the peripheral nervous system often triggered by an infection (classically Campylobacter jejuni).
Poor prognostic features:
There is currently contradictory evidence as to whether a gradual or rapid onset of GBS is associated with a poor outcome.
A 19-year-old man is diagnosed as having myoclonic seizures.
What is the most appropriate first-line antiepileptic?
Correct Answer A:
Epilepsy: treatment:
Most neurologists now start antiepileptics following a second epileptic seizure. NICE guidelines suggest starting antiepileptics after the first seizure if any of the following are present:
Sodium valproate is considered the first line treatment for patients with generalized seizures with carbamazepine used for partial seizures.
Generalized tonic-clonic seizures:
Absence seizures* (Petit mal):
Myoclonic seizures:
Partial seizures:
*Carbamazepine may actually exacerbate absence seizure
**The 2007 SANAD study indicated that lamotrigine may be a more suitable first-line drug for partial seizures although this has yet to work its way through to guidelines
A 27-year-old woman is reviewed due to sudden loss of vision in her left eye. She is known to have severe rheumatoid arthritis and is treated currently with methotrexate, infliximab and prednisolone. She has in the past also used sulfasalazine and hydroxychloroquine. For the past 6 weeks she has developed troublesome headaches. Examination demonstrates bilateral papilloedema.
Which one of the following is most likely to be responsible for this presentation?
Correct Answer B: This patient has developed intracranial hypertension probably secondary to prednisolone. Patients may lose sight suddenly if the optic nerve becomes compressed.
Idiopathic intracranial hypertension:
Idiopathic intracranial hypertension (also known as pseudotumour cerebri and formerly benign intracranial hypertension) is a condition classically seen in young, overweight females.
Risk factors:
*If intracranial hypertension is thought to occur secondary to a known causes (e.g. Medication) then it is of course not idiopathic.
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