Neurological Pathology

Question 1

Define multiple sclerosis.

Answer 1

• chronic autoimmune disease of demyelination

- demyelination is found within the CNS, acute episodes are caused by focal inflammation

Question 2

List symptoms of multiple sclerosis.

Answer 2

• loss of proprioception
• increased urinary urgency
• neuropathic pain
• fatigue
• spacisity
• sensory symptoms

Question 3

What would you expect to find in the lumbar puncture of someone with multiple sclerosis?

Answer 3

• oligoclonal bands

Question 4

Define myasthenia gravis.

Answer 4

• neuromuscular junction disorder where antibodies reduce the amount of ACh in the synapse

Question 5

List symptoms of myasthenia gravis.

Answer 5

• muscle weakness
• diplopia (double vision)
• ptosis

Question 6

How would you treat myasthenia gravis?

Answer 6

• ACh inhibitors
• steroids
• surgery

Question 7

Give two causes of myasthenia gravis.

Answer 7

• a thymic tumour (10%)

- thymic hyperplasia (70%)

Question 8

Define motor neuron disease.

Answer 8

• progressive disease affecting upper and lower motor neurones in the spinal cord

Question 9

How would you investigate motor neuron disease?

Answer 9

• electromyography (EMG)

Question 10

What is the approximate survival rate for motor neuron disease?

Answer 10

• three years

Question 11

Define epilepsy.

Answer 11

• sudden synchronous discharge of cerebral neurons which may be focal or generalised

Question 12

What investigations would you carry out into epilepsy?

Answer 12

• EEG
• MRI
• ECG
• serum calcium

Question 13

How would you treat epilepsy?

Answer 13

• sodium valproate
• carbamezipine
• buccal midazolam (if seizure >5mins)

Question 14

Define a cluster headache.

Answer 14

• recurrent bouts of extremely painful, unilateral headaches that usually last 15min-3hrs

Question 15

How would you treat a cluster headache?

Answer 15

• verapamil (to stop bouts)

- subcutaneous sumatriptin (acute treatment)

Question 16

How would you treat a migraine?

Answer 16

• NSAIDs
• triptans
• beta blockers

Question 17

Define paryoxsmal haemicrania.

Answer 17

• frequent, less severe headaches

Question 18

Define trigeminal neuralgia.

Answer 18

• electric-shock like pain that starts in the course of the manibular nerve

Question 19

How would you treat trigeminal neuralgia?

Answer 19

• carbamezepine

- microvascular decompression

Question 20

Define spina bifida.

Answer 20

• congenital defective closure of the distal neural tube

Question 21

Name and define the types of spina bifida.

Answer 21

occulta - outer part of the vertebra are not completely fused
meningocele - meninges herniate posteriorly, forming a cyst filled with CSF
mylomeningocele - nerve also herniate

Question 22

Define meningitis.

Answer 22

• inflammation of the meninges which can be bacterial or viral

Question 23

List symptoms of meningitis.

Answer 23

• stiff neck
• fever
• altered mental state
• petechial skin rash
• high RR and HR

Question 24

How would you investigate meningitis?

Answer 24

• blood cultures
• lumbar puncture
• CT

Question 25

Define encephalitis.

Answer 25

- inflammation of the brain tissue

Question 26

How would you treat encephalitis?

Answer 26

- IV antivirals | - anticonvulsants

Question 27

Define Duchenne's MD.

Answer 27

- x-linked recessive disorder where dystrophin is missing in muscle

Question 28

How would you investigate Duchenne's MD?

Answer 28

- muscle staining | - biopsy

Question 29

How would you treat Duchenne's MD?

Answer 29

- steroids | - physiotherapy

Question 30

Define subarachnoid haemorrhage.

Answer 30

- spontaneous arterial bleeding into the subarachnoid space, usually caused by a popped berry anaeurysm

Question 31

Define Parkinson's syndrome.

Answer 31

Parkinson's is a loss of dopaminergic neurons caused by Lewy body dementia

Question 32

List symptoms of Parkinson's syndrome.

Answer 32

- bradykinesia - pill-rolling tremor - rigidity - postural inability

Question 33

How would you treat Parkinson's syndrome?

Answer 33

- levodopa - MAO-B inhibitor - dopamine agonist

Question 34

Define Alzheimer's disease.

Answer 34

- a type of dementia characterised by progressive impairment of congitive function in an altert patient

Question 35

How would you treat Alzheimer's disease?

Answer 35

- cholinesterase inhibitor | - NDMA antagonist

Question 36

Define Guillian-Barre syndrome.

Answer 36

- acute demylinating polyneuropathy with an immune-mediated, post-infective presentation

Question 37

Describe the presentation of Guillian-Barre syndrome.

Answer 37

- paralysis 1-3 weeks after an infection - weakness starts distally and moves proximally - sensory loss

Question 38

How would you investigate Guillian-Barre syndrome?

Answer 38

- nerve conduction studies | - lumbar puncture

Question 39

How would you treat Guillian-Barre syndrome?

Answer 39

- immunoglobulins | - LMW heparin