Which one of the following conditions is least recognized as a cause of a seventh nerve palsy?
Correct Answer D:
Facial nerve:
Supply - 'face, ear, taste, tear':
Causes of bilateral facial nerve palsy:
Causes of unilateral facial nerve palsy - as above plus:
LMN vs. UMN:
*May also cause an UMN palsy
A 45-year-old female is diagnosed with a glioma in the parietal lobe after being investigated for new onset seizures.
Which one of the following features is she most likely to develop?
Correct Answer C:
Brain lesions:
The following neurological disorders/features may allow localization of a brain lesion:
Gross anatomy: Parietal lobe lesions:
Occipital lobe lesions:
Temporal lobe lesion:
Frontal lobes lesions:
Cerebellum lesions:
More specific areas:
A 71-year-old man is admitted to the Emergency Department. His family report that since yesterday he has been very 'clumsy' and unsteady on his feet. This morning he started to complain of numbness down his left side. On examination you notice that he has a right-sided Horner's syndrome and horizontal nystagmus. Examination of the peripheral nervous system confirms the sensory loss on the left side.
Where is the lesion most likely to be?
Lateral medullary syndrome:
Lateral medullary syndrome, also known as Wallenberg's syndrome, occurs following occlusion of the posterior inferior cerebellar artery.
Cerebellar features:
Brainstem features:
A 76-year-old man is admitted with a right hemiparesis. On examination his blood pressure is 120/78 mmHg, pulse 84 bpm and oxygen saturations 96% on room air. A CT scan excludes intracerebral haemorrhage and he is given aspirin 300mg.
What is the most appropriate management with regards to oxygen therapy in the first 12 hours following admission?
Correct Answer C: Both the NICE stroke guidelines and British Thoracic Society oxygen guidelines do not support giving oxygen in this scenario.
Oxygen therapy:
The British Thoracic Society published guidelines on emergency oxygen therapy in 2008. The following selected points are taken from the guidelines. Please see the link provided for the full guideline.
In patients who are critically ill (anaphylaxis, shock etc) oxygen should initially be given via a reservoir mask at 15 l/min. Hypoxia kills. The BTS guidelines specifically exclude certain conditions where the patient is acutely unwell (e.g. myocardial infarction) but stable.
Oxygen saturation targets:
Management of COPD patients:
Situations where oxygen therapy should not be used routinely if there is no evidence of hypoxia:
A 23-year-old female has a lumbar puncture to exclude a subarachnoid haemorrhage following a negative CT scan.
Which one of the following factors would be most likely to influence the incidence of post-lumbar puncture headache?
Correct Answer E:
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:
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