Neurology for neurosurgeons

Question 1

What is the difference between delirium and dementia?

Answer 1

Delirium is an acute confusional state, has motor signs, slurred speech, altered consciousness, hallucinations, and EEG shows pronounced diffuse slowing.

Question 2

When would you do a brain biopsy for dementia?

Answer 2

For an unexplained neurodegenerative process, preferably those with focal abnormality on MRI.

In those without focal abnormality brain biopsy should be performed within an investigative protocol

Question 3

What is the difference between common migraine and classic migraine?

Answer 3

Classic Migraine is with aura/neurological deficit. resolves in less than 24 hours (complicated migraine resolves in less than 30 days!)

Question 4

How do you treat refractory cluster headache?

Answer 4

Percutaneous RF ablation of sphenopalatine ganglion
ONS
hypothalamic DBS

Question 5

What causes parkinsonism?

Answer 5

Loss of dopamine mediated inhibition of effects of Acetylcholine on basal ganglia

Question 6

What is the classic triad of Parkinson’s disease?

Answer 6

resting tremor, bradykinesia, cogwheel rigidity

Question 7

How do you differentiate Idiopathic parkinsons from secondary?

Answer 7

Gradual onset of symptoms in Parkinson’s and responds well to levodopa, no midline features (ataxia, sphincter disturbance)

Question 8

What is the classic histological feature of Idiopathic parkinsons?

Answer 8

Lewy bodies (eosinophilic intraneural hyaline inclusions)

Question 9

Which neurones are affected in Parkinsons disease?

Answer 9

dopaminergic neurones of the pars compacta of the substantia nigra

This results in reduced dopamine in the neostriatum (caudate, putamen, Globus pallidus)

Question 10

Symmetrical high signal abnormalities in globus pallidus with no findings on T2 or GRASS

Answer 10

Manganese poisoning

Question 11

What does CO poisoning look like on CT

Answer 11

bilateral hypodensity in basal ganglia in globus pallidus

Question 12

What is Shy-Drager syndrome?

Answer 12

Multi-system atrophy (MSA) or Parkinsonism PLUS idiopathic orthostatic hypotension PLUS autonomic dysfunction. Degeneration of preganglionic lateral horn neurones of thoracic spinal cord

Question 13

What is Steele-Richardson-Olszewski syndrome?

Answer 13

Progressive supranuclear palsy

Triad of -
supranuclear palsy
Pseudobulbar palsy
axial dystonia

Question 14

What percentage of MS patients have trigeminal neuralgia, what is different about their TN?

Answer 14

2%

Occurs at a younger age and is more often bilateral.

Question 15

What is the likely cause for an internuclear ophthalmoplegia?

Answer 15

MS affecting the MLF