6-hours post-stroke + AFib + no haemorrhage on CT scan = best acute management?
300mg Aspirin
- Alteplase should only be used within 4.5 hours of stroke
Chronic IV use + foot and wrist drop with pain + haemorrhage in nail folds = diagnosis?
Hepatitis C-associated cryoglobulinaemia
- Painful multifocal neuropathy (mononeuritis multiplex) and nail fold infarcts point towards vasculitis
Acute abdominal pain + reduced lower limb power and absent reflexes + high level of delta-aminolevulinic acid + basophilic stippling + same picture in sibling last year = diagnosis?
Lead poisoning
- High delta-aminolevulinic acid levels can be caused by Lead Poisoning and Acute Intermittent Porphyria, however only lead poisoning causes basiphilic stippling
Encephalitis + hypodensity in temporal lobes + dysphasia + raised cell and protein counts in CSF with normal glucose = diagnosis and treatment?
Herpes simplex encephalitis and treated with IV fluids and Aciclovir for 14 days
- Confirmation with CSF PCR for HSV, and no role of any other medication or steroids
Management of recurrent migraines resistant to sumatriptan + asthma = ?
Prophylactic Topiramate (anti-epileptic)
- If intolerant to one triptans, chances are the intolerance extends to the whole family. Prophylactic beta-blockers are contraindicated by asthma.
Woman on warfarin for PE + weakness of knee extension and hip flexion + absent knee jerk reflex + decreased sensation in anterior tigh and medial distal leg = whereis the lesion?
Femoral nerve
- Damage to the Femoral Nerve by retroperitoneal haemorrhage secondary to warfarin therapy. Weakness of quadriceps (knee extension) and iliopsoas (hip flexion), and dermatome of Femoral Nerve
Right homonymous hemianopia with sparing of central field = site of lesion?
Left occipital lobe, territory of posterior cerebral artery
- This stroke is called Hanzi stroke
30yo with 3 month history of dysarthria + clumsiness + forgetful about simple tasks + fidgety with involuntary movements of arms and legs + asterixis + father died of ‘psychiatric causes’ = diagnosis?
Wilson’s disease
- While Huntington’s chorea presents similarly, the presence of liver damage (asterixis) points towards Wilson’s which is the unifying diagnosis
Diplopia + 3rd 4th and 6th nerve palsy + sensory changes of 5th dermatome (i.e maxilla) = where is the lesion?
Cavernous sinus
- Cavernous sinus contains carotid artery + sympathetic plexus with 3, 4, 6th CN, + ophthalmic or sometimes maxillary branches of 5th CN
Complete cord syndrome (spinothalamic+corticospinal+dorsal columns) + lymphocytosis in CSF with normal glucose and protein and negative oligoclonal bands = diagnosis?
Post-infection transverse myelitis (post-viral)
16 yo + weakness of all limbs over an hour + arreflexia + hypokalaemia = diagnosis?
Hypokalaemic periodic paralysis
- Autosomal dominant disorder with onset in teen. Precipitated by large carbohydrate meals, sodium-rich meals or after sleep or rest. Never occurs during exercise
Sever back and neck spasms and pain + prodromal illness (sore throat, myalgia, fatigue…) or gastroenteritis + flaccid tone unilaterally = diagnosis and management?
- Poliomyelitis
- Managed by supportive care
Agitation during sleep in patient with Parkinson’s = management?
Melatonin or clonazepam
- Rapid eye movement sleep behaviour disorder is common in Parkinson’s patients and may be the harbinger of the condition
Progressive lower limb weakness + preserved knee reflex but absent ankle reflex + bilateral extensor plantars + history of prostate cancer and raisedd ALP + normal calcium and PTH = which investigation?
MRI spine
- Compression of conus medullaris causes UMN and LMN symptoms
