Neurological Diagnoses and Management Quiz

Neurological Diagnoses and Management

• Brown-Sequard Syndrome: Caused by viral infection, presents with right-sided weakness, left-sided temperature/pain loss, diminished vibration in right foot, brisk reflexes and Babinski sign on right side.

• Pain Management in Cancer Patients: Inadequate pain control is a leading reason for patients with metastatic cancer wanting to die. Addressing pain management is crucial.

• Restless Leg Syndrome: Often caused by iron deficiency. Initial management step is checking serum iron and ferritin levels. If levels are normal, dopamine agonists (e.g., pramipexole, ropinirole) are the next step.

• Restless Legs Syndrome and Parkinson's Disease: Patients with restless legs syndrome have an increased risk of developing Parkinson's disease later in life, potentially due to dopamine transmission issues.

• Carotid Sinus Hypersensitivity: Loss of consciousness during shaving, with a negative tilt-table test, suggests this condition. A positive tilt-table test would point to vasovagal syncope.

• Diabetic Retinopathy: Hard exudates, cotton wool spots, and scattered hemorrhages in fundoscopic examination indicate diabetic retinopathy.

• Tardive Dyskinesia and Metoclopramide: Metoclopramide, a D2 antagonist, can cause tardive dyskinesia, prolong the QT interval, and lead to hyperprolactinemia. This is important to differentiate from antipsychotic drugs.

• Bupropion and Seizures: Bupropion, an antidepressant, can cause seizures. This is important to note.

• Frontal Lobe Injury - Conceptual Planning: Frontal lobe injury, (e.g. from a car accident), can lead to deficits in conceptual planning.

Vitamin B1 Deficiency (Wernicke's Encephalopathy)

• Acute Alcoholism and Wernicke's Encephalopathy: Administering B1 (thiamine) in acutely intoxicated alcoholics is crucial. B1 administration significantly reduces the risk of anterograde amnesia. (Wernicke's triad mnemonic is helpful here; A COW → Ataxia, Confusion, Ophthalmoplegia, Wernicke).

Alcohol Withdrawal Symptoms

• Alcohol Withdrawal Tremors: Sudden reduction in alcohol intake (from 12 beers a day to 4 beers a day) can cause tremulousness leading to possible delirium tremens or alcoholic hallucinosis. Administering chlordiazepoxide (anxiety med) can help prevent or treat these symptoms.

Inflammatory Muscle Conditions

• Polymyositis: Characterized by high ESR and CK (creatine kinase) levels, and proximal muscle weakness. Diagnosis can involve anti-Jo1/-Mi2 antibodies, or electromyography/nerve conduction studies. Muscle biopsy provides definitive diagnosis.

• Polymyalgia Rheumatica (PMR): High ESR, muscle pain and stiffness but usually no muscle weakness or high CK. No specific blood tests are commonly used to definitively diagnose PMR.

• Difference Between PMR and Polymyositis: The key differentiating factor is the presence or absence of muscle weakness and elevated CK levels.

• Temporal Arteritis: Temporal headaches, muscle pain, and stiffness with elevated ESR may indicate temporal arteritis. Crucial next step is giving intravenous methylprednisolone immediately, followed by a biopsy of the temporal artery.

Neurological Findings from Cancer

• Spinal Cord Compression from Cancer: Suspect spinal cord compression (from cancer or trauma) if a patient with cancer presents with neurologic findings. If a corticosteroid is listed, administer it first, before considering an MRI.

• Breast Cancer/Prostate Cancer and Neurologic Finding: Neurologic findings in patients with either breast or prostate cancer may be due to metastasis. Administer high-dose intravenous dexamethasone or steroids if listed before an MRI to assess and mitigate the potential for spinal compression.

Test your knowledge on various neurological disorders and their management strategies. This quiz covers conditions like Brown-Sequard Syndrome, Restless Leg Syndrome, and pain management in cancer patients. Evaluate your understanding of diagnosis and treatment approaches in neurology.