A 27-year-old man presents with a history of fits consistent with tonic-clonic seizures.
What is the most suitable first-line treatment?
Correct Answer C:
Epilepsy medication: first-line:
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
Which of the following features is least likely to be found in a patient with tuberous sclerosis?
Correct Answer E: Lisch nodules are seen in neurofibromatosis.
Tuberous sclerosis
Tuberous sclerosis (TS) is a genetic condition of autosomal dominant inheritance. Like neurofibromatosis, the majority of features seen in TS are neuro-cutaneous.
Cutaneous features:
Neurological features:
Also
*These of course are more commonly associated with neurofibromatosis. However a 1998 study of 106 children with TS found café-au-lait spots in 28% of patients
Which of the following visual field changes would be most consistent with a left parietal lobe lesion?
Correct Answer E:
Visual field defects The main points for the exam are:
A congruous defect simply means complete or symmetrical visual field loss and conversely an incongruous defect is incomplete or asymmetric. Please see the link for an excellent diagram.
Homonymous hemianopia:
Homonymous quadrantanopias*:
Bitemporal hemianopia:
*This is very much the 'exam answer'. Actual studies suggest that the majority of quadrantanopias are caused by occipital lobe lesions. Please see the following link for more details: http://www.ncbi.nlm.nih.gov/pubmed/9109741
A 52-year-old man is prescribed apomorphine.
What type of receptors does apomorphine act on?
Correct Answer D: Apomorphine is one of the older dopamine receptor agonists. Newer agents such as ropinirole and cabergoline have since been developed.
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
An obese 24-year-old female presents with headaches and blurred vision. Examination reveals bilateral blurring of the optic discs but is otherwise unremarkable with no other neurological signs. Blood pressure is 130/74 and she is apyrexial.
What is the most likely underlying diagnosis?
Correct Answer E: Obese, young female with headaches / blurred vision think idiopathic intracranial hypertension.
The combination of a young, obese female with papilloedema but otherwise normal neurology makes idiopathic intracranial hypertension the most likely diagnosis.
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.
Features:
Risk factors:
Management:
*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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