A 75-year-old female presents with weakness of her left hand. On examination wasting of the hypothenar eminence is seen and there is weakness of finger abduction. Thumb adduction is also weak.
Where is the lesion most likely to be?
Correct Answer E:
Ulnar nerve:
Overview:
Motor to:
Sensory to:
Patterns of damage:
Damage at wrist:
Damage at elbow:
Which type of motor neuron disease carries the worst prognosis?
Correct Answer B:
Motor neuron disease: types:
Motor neuron disease is a neurological condition of unknown cause which can present with both upper and lower motor neuron signs. It rarely presents before 40 years and various patterns of disease are recognized including amyotrophic lateral sclerosis, primary lateral sclerosis, progressive muscular atrophy and progressive bulbar palsy. In some patients however, there is a combination of clinical patterns.
Amyotrophic lateral sclerosis (50% of patients):
Primary lateral sclerosis:
Progressive muscular atrophy:
Progressive bulbar palsy:
A 65-year-old man is referred to the neurology outpatient clinic due to a resting tremor of his right hand. A diagnosis of Parkinson's disease is made. He is otherwise well and is not currently disabled by his symptoms.
What is the most appropriate treatment?
Parkinson's disease: management:
Currently accepted practice in the management of patients with Parkinson's disease (PD) is to delay treatment until the onset of disabling symptoms and then to introduce a dopamine receptor agonist. If the patient is elderly, levodopa is sometimes used as an initial treatment.
Dopamine receptor agonists:
Levodopa:
MAO-B (Monoamine Oxidase-B) inhibitors:
Amantadine:
COMT (Catechol-O-Methyl Transferase) inhibitors:
Antimuscarinics:
*Pergolide was withdrawn from the US market in March 2007 due to concern regarding increased incidence of valvular dysfunction.
Which one of the following features is most associated with temporal lobe lesions?
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 brain areas lesions:
Each of the following features are seen in myotonic dystrophy, except:
Dystrophia myotonica - DM1:
Myotonic dystrophy:
Myotonic dystrophy (also called dystrophia myotonica) is an inherited myopathy with features developing at around 20-30 years old. It affects skeletal, cardiac and smooth muscle. There are two main types of myotonic dystrophy, DM1 and DM2.
Genetics:
Autosomal dominant x a trinucleotide repeat disorder
The key differences are listed in table below:
General features:
Other features:
Click to expand