Neurology Quiz 1

Ref: Harrison 20th p 2069; Harrison 19th edition, page no: 1771
 Locked in state is seen due to damage to ventral pons secondary to basilar artery damage.
 Bilateral Corticospinal damage leads Quadriplegia
 Bilateral Corticobulbar damage to 3rd, 4th, 6th and 7th nerves leads to loss of horizontal gaze, facial diplegia.
 Bilateral Corticobulbar damage to 9,10,12th nerves leads to aphonia and tongue paralysis
 Brain stem damage leads to loss of respiratory function.

Ref: Harrison 20th p 3081; Harrison 19th edition,
 Thrombolysis for AIS is ideally performed in a 3 hour window period. However due to favourable results now the usage has been extended upto 4.5 hours from onset of symptoms of stroke.
 Time of stroke onset is defined as time when the patient’s symptoms were witnessed to begin or time when the patient was last seen as normal.

(Ref: Harrison 20th p 186; Harrison 19th edition, page 203)
Patients with Benign Intracranial Hypertension /Idiopathic intracranial hypertension (IIH) usually present with symptoms related to increased intracranial pressure (ICP) and papilledema,
• Symptoms include headache, transient visual obscurations and diplopia due to unilateral or bilateral abducens nerve
• Hence choice B and D are ruled out
Diagnostic pointers to presence of pseudotumour cerebri/ idiopathic intracranial hypertension (by international society for headache)
1. High rate of occurrence in obese women during the childbearing years.
2. Reduced conductance to CSF outflow.
3. Normal ventricular size; no hydrocephalus
4. No histologic evidence of cerebral edema
Clinical features of pseudotumour cerebri
1 Elevated intracranial pressure (VIth CN palsy may be seen as a false localizing sign of raised intracranial tension)
2. Normal or Small sized Ventricular system
3. No focal neurological signs
4 Papilledema (enlarged blind spot in visual fluid)
5. Normal CSF findings
6. Normal CT scan, MRI and isotope Scan
7. Excessive slow-wave activity on ECG

(Ref: Harrison 20th p 2069; Harrison 19th edition, page 1772)
Foraminal brain herniation leads to compression of medulla and respiratory arrest.
• Third nerve palsy causing ipsilateral pupillary dilatation and ipsilateral hemiplegia occurs in uncal (midbrain) herniation
• Locked in state occurs due to lesion of ventral pons.

(Ref: Harrison 20th p 3067; Harrison 19th p 2559)
• The patient is in second trimester of pregnancy
• Organogenesis occurs in early pregnancy and damage may have already occurred.
• The fetus may already be having a NTD and hence there is no point in changing her treatment plan.
• If patient had presented when she was planning her pregnancy, the course of action would be to gradually reduce valproate dose and initiate lamotrigine.

(Ref: Harrison 20th p 3051; Harrison 19th edition, page 2542)
The patient is exhibiting focal seizures which are accompanied by transient impairment of patient's ability to maintain normal contact with environment.
Chewing, lip smacking, swallowing or picking movements of hands are called automatisms.
The full recovery after the episode may range from seconds to an hour. Due to involvement of temporal lobe, patient was having abnormal olfactory sense before the episode.