Capsule

Question 1

Define TIA

Answer 1

• sudden onset of neurological signs or symptoms
• due to temporary occlusion of part of the cerebral circulation
• with resolution of symptoms within 24 hours
• carotid stenosis most common cause

Question 2

Investigations for TIA

Answer 2

• carotid doppler ultrasound indicated
• CT and MR angiography used to further evaluate more significant carotid stenosis
• ECHO should be taken

Question 3

Surgery for carotid stenosis is indicated when what percentage of the artery is stenosed:

Answer 3

at least 70%

Question 4

Would you give anticoagulation or antiplatelet therapy for treatment of TIA

Answer 4

Antiplatelet therapy : aspirin or clopidogrel

Question 5

53 Male w/ eye problem.
PC: right eyelid droopy 1 month.

SH: no substance misuse, smoker 20/day for last 30 years and drinks 2-3 glasses of wine per evening.

Lost 6Lb in weight. appetite reduced.

No limb weakness or swallowing/ respiratory difficulty except for chronic cough.

Possible differential diagnoses:

Answer 5

Myasthenia gravis –> ptosis and/or diplopia

Horner’s syndrome –> ptosis, miosis (small pupil), anhidrosis (decreased sweating), enophthalmos (sunken eye)

Wernickes encephalopathy –> eye signs, ataxia and confusion

Question 6

Damage to which parts of the nervous system can cause ptosis?

Answer 6

• dysfunction of the levator palpebrae superioris muscle
• innervated by oculomotor nerve (III)
• dysfunction of superior tarsal muscle (innervated by cervical sympathetic chain)

3rd cranial nerve arises from its nucleus in the MIDBRAIN

Question 7

Tumour commonly causing Horner’s syndrome

Answer 7

Pancoast tumour
- tumour at apex of lung

Question 8

If headaches were due to raised ICP, what would you expect a visual field assessment to show:

Answer 8

Enlarged blind spots and constricted fields

May be loss of central vision and visual acuity

Question 9

What features may help distinguish Parkinson’s disease or drug induced parkinsonism?

Answer 9

• dyskinesia (chorea, side effect of levodopa)
• levodopa improves symptoms (levodopa usually helps PD, not DI)
• unilateral resting tremor (DI less likely to have unilateral upper limb coarse rest tremor)

Question 10

Important scan to do if worried about patients developing Parkinson’s disease

Answer 10

DaTscan
- can show loss of dopaminergic neurons implying PD?

Question 11

What is a common manifestation of CNS inflammation, particularly in multiple sclerosis and neuromyelitis optica?

Answer 11

Optic neuritis

Question 12

Multiple sclerosis:

You send for CSF and blood for oligoclonal bands and the rest is reported to be suggestive of multiple sclerosis, What does this mean?

Answer 12

Antibodies in CSF which are not present in serum

• Immunoglobulins can cross BBB

Question 13

What treatment is given for relapsing remitting MS

Answer 13

For acute treatment: methylprednisolone

For when symptoms have almost resolved
–> beta-interferon
–> dimethyl fumarate