Neuro

Question 1

What is optic neuritis?

Answer 1

Optic neuritis is the most common presentation of multiple sclerosis.

It involves demyelination of the optic nerve.

Question 2

What is a central scotoma?

Answer 2

A central scotoma is an enlarged central blind spot.

It is a key feature of optic neuritis.

Question 3

What disease is characterized by pain with eye movement, impaired colour vision, RAPD and a central scotoma

Answer 3

optic neuritis.

Question 4

What does a relative afferent pupillary defect indicate?

Answer 4

A relative afferent pupillary defect indicates a problem with the optic nerve.

It is assessed using the swinging flashlight test. The affected eye constricts more when shining a light in the other eye than the affected eye. There is a reduced pupil responsive to shining light in the eye affected

Question 5

Causes of optic neuritis

Answer 5

MS
SARCOID
SLE
SYPHILIS
MEASLES/ MUMPS
NEUROMYELITIS OPTICA
LYME DISEASE

Question 6

What cranial nerves are affected by lesions that cause double vision and nystagmus?

Answer 6

Oculomotor (CN III), trochlear (CN IV), and abducens (CN VI)

These nerves are responsible for controlling eye movements.

Question 7

What does oscillopsia refer to?

Answer 7

The visual sensation of the environment moving and being unable to create a stable image

Oscillopsia can be distressing and is often associated with vestibular disorders.

Question 8

What condition is caused by a lesion in the medial longitudinal fasciculus?

Answer 8

Internuclear ophthalmoplegia

This condition affects the coordination of eye movements.

Question 9

What do the nerve fibres of the medial longitudinal fasciculus connect?

Answer 9

Cranial nerve nuclei that control eye movements

Specifically, the 3rd, 4th, and 6th cranial nerve nuclei.

Question 10

What is the effect of a lesion in the medial longitudinal fasciculus on eye movement?

Answer 10

Impaired adduction on the same side as the lesion and nystagmus in the contralateral abducting eye

This results in the affected eye’s inability to move towards the nose during adduction.

Question 11

What type of disorder does a lesion in the abducens (CN VI) cause?

Answer 11

Conjugate lateral gaze disorder

This disorder affects the ability of both eyes to move together laterally.

Question 12

When looking laterally in the direction of the affected eye due to an abducens lesion, what happens to the affected eye?

Answer 12

The affected eye will not be able to abduct

For example, in a left abducens lesion, the left eye will not move left.

Question 13

True or False: In a left abducens lesion, when looking to the left, the right eye will abduct.

Answer 13

False

The right eye will adduct instead.

Question 14

Fill in the blank: The term ‘conjugate’ in conjugate lateral gaze means _______.

Answer 14

Connected

This indicates that both eyes are supposed to move together.

Question 15

What are some examples of focal weakness in multiple sclerosis?

Answer 15

• Incontinence
• Horner syndrome
• Facial nerve palsy
• Limb paralysis

These symptoms indicate focal neurological deficits associated with multiple sclerosis.

Question 16

What are some examples of focal sensory symptoms in multiple sclerosis?

Answer 16

• Trigeminal neuralgia
• Numbness
• Paraesthesia (pins and needles)
• Lhermittes sign

These symptoms reflect sensory disturbances that can occur in multiple sclerosis.

Question 17

What does Lhermitte’s sign indicate?

Answer 17

It indicates disease in the cervical spinal cord in the dorsal column.

Lhermitte’s sign is characterized by an electric shock sensation traveling down the spine when flexing the neck.

Question 18

What is Lhermitte’s sign?

Answer 18

An electric shock sensation that travels down the spine and into the limbs when flexing the neck.

This sign is caused by stretching the demyelinated dorsal column.

Question 19

What is transverse myelitis?

Answer 19

A site of inflammation in the spinal cord resulting in sensory and motor symptoms depending on the lesion location.

Transverse myelitis can lead to various neurological deficits based on the affected area.

Question 20

What is ataxia?

Answer 20

A problem with coordinated movement.

Ataxia can manifest as sensory or cerebellar types.

Question 21

What causes sensory ataxia?

Answer 21

Loss of proprioception.

Proprioception is the ability to sense the position of joints.

Question 22

What is a positive Romberg’s test and what is it indicative of?

Answer 22

Loss of balance when standing with eyes closed.

This is a common finding in sensory ataxia.

Question 23

What can sensory ataxia lead to?

Answer 23

Pseudoathetosis.

Pseudoathetosis is characterized by involuntary writhing movements.

Question 24

What lesion can cause sensory ataxia?

Answer 24

Lesion in the dorsal columns of the spine.

The dorsal columns are responsible for proprioception.

Question 25

What causes cerebellar ataxia?

Answer 25

Problems with the cerebellum coordinating movement. ## Footnote Cerebellar ataxia suggests a lesion in the cerebellum.

Question 26

What investigation can support the diagnosis of MS

Answer 26

MRI scans

Question 27

What can a lumbar puncture detect in the cerebrospinal fluid (CSF) in MS

Answer 27

Oligoclonal bands

Question 28

How are MS relapses managed

Answer 28

Steroids - methylpred NICE: 500mg orally daily for 5 days 1g IV 3-5 days (severe/ orals have failed prev)

Question 29

What type of inheritance is Facioscapulohumeral muscular dystrophy?

Answer 29

Dominantly inherited ## Footnote This means that only one copy of the mutated gene is sufficient to cause the disorder.

Question 30

At what age does Facioscapulohumeral muscular dystrophy typically present?

Answer 30

Usually in the first and second decades of life ## Footnote However, it may present at any age, including infancy, though this is rare.

Question 31

What is the typical progression pattern of muscle involvement in Facioscapulohumeral muscular dystrophy?

Answer 31

Starts in the face and progresses to the shoulder girdle, humeral muscles, abdominal muscles, and then the anterolateral compartment of the leg ## Footnote This reflects the characteristic downward progression of the disease.

Question 32

What is the variability in disease severity for Facioscapulohumeral muscular dystrophy?

Answer 32

Very variable and progression is very slow ## Footnote Some patients may remain asymptomatic.

Question 33

What percentage of patients with Facioscapulohumeral muscular dystrophy are asymptomatic?

Answer 33

As many as one third ## Footnote This highlights the variability in disease manifestation.

Question 34

What initial symptoms indicate weakness in the facial muscles?

Answer 34

Weakness starts in the orbicularis oculi, mouth, and cheek ## Footnote These symptoms can lead to characteristic signs during sleep and facial activities.

Question 35

Which muscles are spared in Facioscapulohumeral muscular dystrophy?

Answer 35

Extraocular and pharyngeal muscles ## Footnote This sparing is significant in distinguishing the disease from other muscular dystrophies.

Question 36

What is a characteristic sign of weakness in facial muscles?

Answer 36

Eyes remain slightly open when asleep ## Footnote This sign is particularly notable in young children.

Question 37

What difficulties may suggest weakness of facial muscles?

Answer 37

Difficulties with pursing lips to whistle, drinking through a straw, or blowing up balloons ## Footnote These functional challenges can indicate muscle involvement.

Question 38

What is the most characteristic sign of Facioscapulohumeral muscular dystrophy?

Answer 38

Winging of the scapula ## Footnote This sign is a key diagnostic feature.

Question 39

How does the scapula appear in patients with winging?

Answer 39

More lateral than normal and moves upwards with shoulder abduction ## Footnote This change is due to weakness in specific shoulder muscles.

Question 40

Which shoulder muscles may be spared in Facioscapulohumeral muscular dystrophy?

Answer 40

Deltoid muscle ## Footnote Selective weakness can lead to significant functional impairment.

Question 41

Fill in the blank: Facioscapulohumeral muscular dystrophy shows selective weakness of the _______ muscles.

Answer 41

thoracoscapular ## Footnote This selective weakness contributes to the characteristic winging of the scapula.

Question 42

What is the most common type of epilepsy in childhood

Answer 42

Benign Rolandic epilepsy