Neurology 1

Question 1

Which AED classically is associated with hirsutism (in women), gingival hyperplasia and facial deformities/changes.

How does this drug also case ataxia and dysmetria with long term use?

Answer 1

PHENYTOIN

Causes cerebellar shrinking, which can present with cerebellar signs.

Question 2

“Saturday night palsy” or Radial nerve entrapment, occurs when there is prolonged arm pit entrapment. IE, a drunk falls asleep with arm hanging over something.

What is the classic TRIAD of symptoms?

Answer 2

1. Weakness of extensors of wrist and fingers (wrist drop)
2. Weakness of tricepts
3. Problems with supination

Question 3

Describe the deficit in the following mononeuropathies:

1. Median Nerve
2. Ulnar Nerve
3. Radial Nerve

Answer 3

1. Median N. = Pain/numbness/tingline of thumb and 2nd/3rd digits.
2. Ulnar N. = Weakness of hand grip- due to…
   - Weakness of flexor carpi ulnaris
   - Weakness of intrinsic hand muscle
   - Weakness of 4th and 5th digit flexors.
3. Radial N. = Weakness of extensors (hand, elbow) and problem with supination.

Question 4

A patient is treated with an MAOI-A for depression and is diagnosed with Parkinsons Disease.

1. Why is Levodopa/carbidopa contraindicated with MAOI-A use?

How long should the washout period be before starting Levodopa/Carbidopa?

Answer 4

1. MAOIs are post synaptic enzymatic metabolizers of Dopamine.

Concurrent use of MAOI plus levodopa/carbidopa can decrease efficacy of Levodopa/Carbidopa and WORSEN PD symptoms.

2. 2 week washout period.

Question 5

Damage to these frontal lobe areas would cause:

1. Orbitofrontal region
2. Dorsolateral frontal region
3. Medial frontal region

Answer 5

1. Orbitofrontal region = personality change (disinhibition, mood lability, irritability, euphoria, poor judgment, distractibility)
2. Dorsolateral frontal region= Executive function change
3. Medial frontal region = Apathy syndrome

Question 6

Which brain lesion is associated with MANIA and which with DEPRESSION?

Answer 6

Mania = R frontal

Depression = L frontal

Question 7

Which area of the brain is the main site for serotonergic neuronal cell bodies?

Answer 7

Raphe Nuclei of brain stem, mostly in PONS.

Question 8

What is the pathophysiology of Wilson’s disease?

Answer 8

Problem incorporating copper into Ceruloplasmin and diminished biliary excretion of Cu.

Leads to excessive Cu build up in organs. In the brain, especially in Basal Ganglia.

Question 9

What is the genetic inheritance pattern of Wilson’s disease and what chromosome is the gene located in?

Answer 9

AUTOSOMAL RECESSIVE

CHROMOSOME 13.

Question 10

Most common etiology of intracranial hemorrhage?

Answer 10

HTN.