Neurology Practice Questions

Q: Rademecker complex in EEG is seen in -

SSPE. ***SSPE*** - **Subacute sclerosing panencephalitis (SSPE)** is a rare, chronic, progressive encephalopathy characterized by a distinctive EEG pattern known as the **Rademecker complex**. - The **Rademecker complex** (also called Rademecker complexes or periodic stereotyped complexes) consists of high-amplitude, generalized, polyphasic delta waves that occur periodically every 4-15 seconds. *Kuru* - **Kuru** is a transmissible spongiform encephalopathy (TSE) with neurological symptoms like ataxia and tremors, but it does not typically show the **Rademecker complex** on EEG [1]. - EEG abnormalities in Kuru are generally non-specific and may include diffuse slowing, but not periodic complexes [1]. *cCJD* - **Classic Creutzfeldt-Jakob disease (cCJD)**, a prion disease, often shows characteristic **periodic sharp wave complexes (PSWCs)** on EEG. - These PSWCs are typically biphasic or triphasic, occurring at a frequency of 0.5-2 Hz, and are distinct from the slower, high-amplitude Rademecker complexes seen in SSPE. *vCJD* - **Variant Creutzfeldt-Jakob disease (vCJD)**, unlike cCJD, rarely or never shows the characteristic **periodic sharp wave complexes (PSWCs)** on EEG. - EEG findings in vCJD are usually non-specific, often showing generalized slowing without the unique periodic complexes seen in SSPE or cCJD.

Q: Herpes virus involves which lobe?

Temporal. ***Temporal*** - Herpes virus (specifically **HSV-1**) often causes **encephalitis**, and the **temporal lobes** are the most common and severely affected regions [1]. - This predilection for the temporal lobes often leads to characteristic symptoms such as **memory deficits**, **aphasia**, and **behavioral changes** [1]. *Occipital* - While encephalitis can be diffuse, direct and primary involvement of the **occipital lobe** as the main site of herpes simplex encephalitis is **uncommon**. - Conditions like **posterior reversible encephalopathy syndrome (PRES)** or **cerebral amyloid angiopathy** are more typically associated with occipital involvement. *Parietal* - Although the **parietal lobe** can be affected in severe or widespread encephalitis, it is **not the primary or most frequent site** of herpes simplex encephalitis. - Damage to the parietal lobe would typically result in **sensory deficits**, **spatial disorientation**, or **neglect**. *Frontal* - The **frontal lobes** can be involved in herpes simplex encephalitis, often as part of a more extensive disease affecting the temporal lobes. - However, the **temporal lobes are more consistently and severely impacted**, accounting for the majority of the characteristic clinical presentation [1].

Q: Reversible dementia is seen in all EXCEPT:

Alzheimer's. ***Alzheimer's*** - Alzheimer's disease is a **progressive neurodegenerative disorder** characterized by the accumulation of **beta-amyloid plaques** and **neurofibrillary tangles**, leading to irreversible cognitive decline. - While symptoms can be managed, the underlying pathology of Alzheimer's is **irreversible** and gets progressively worse. *Hypothyroidism* - **Severe or untreated hypothyroidism** can lead to cognitive impairment resembling dementia, often referred to as "myxedema madness." - This cognitive dysfunction is typically **reversible** with appropriate **thyroid hormone replacement therapy**. *Wernicke's encephalopathy* - This condition is caused by a **thiamine (vitamin B1) deficiency**, commonly seen in chronic alcoholics. - The cognitive deficits, including confusion and memory problems, are **reversible** if treated promptly with **thiamine supplementation**. *Head trauma* - **Acute cognitive deficits** following mild to moderate traumatic brain injury (TBI) can be **reversible** with rehabilitation and recovery time. - However, it's important to note that **severe TBI** and **chronic traumatic encephalopathy (CTE)** typically cause **irreversible** dementia. - In the context of this question, head trauma is generally classified under reversible causes when referring to **acute post-traumatic cognitive impairment** that can improve with treatment.

Q: A 60-year old female presented with decreased movements for the last 2 years with rigidity and vertical large square wave jerks. The most likely diagnosis is?

Progressive supranuclear palsy. ### Progressive supranuclear palsy - The combination of **decreased movements**, **rigidity**, and especially **vertical large square wave jerks** is highly characteristic of progressive supranuclear palsy (PSP). - **Vertical gaze palsy** is a cardinal feature, and square wave jerks are often an early sign preceding overt gaze limitation. *Parkinson's disease* - While it presents with **bradykinesia** (decreased movements) and rigidity [1], [2], features like **vertical large square wave jerks** are not typical. - Parkinson's is primarily characterized by **resting tremor**, **postural instability**, and often a good response to levodopa [1]. *Lewy body dementia* - This condition presents with **cognitive fluctuations**, **recurrent visual hallucinations**, and **spontaneous parkinsonism**, but **vertical large square wave jerks** are not a defining feature. - The parkinsonism in LBD is typically milder than in Parkinson's disease. *Multisystem atrophy* - MSA is characterized by parkinsonism, cerebellar ataxia, and autonomic dysfunction (**orthostatic hypotension**, **urinary incontinence**), but **vertical large square wave jerks** are not a core diagnostic criterion. - The rigidity in MSA is often less responsive to levodopa compared to Parkinson's.

Q: Which condition is associated with periodic discharges on EEG at 4-second intervals?

SSPE. ***SSPE*** - **Subacute sclerosing panencephalitis (SSPE)** is a rare, fatal, progressive brain disorder characterized by inflammation and degeneration of the brain. - The distinctive EEG pattern consists of **periodic high-amplitude, slow-wave complexes** that recur every 4-15 seconds, often every 4-8 seconds, making 4-second intervals a key indicator. *Absence Seizure* - Absence seizures typically manifest as **brief staring spells** with impaired consciousness, lasting only a few seconds. - The EEG in absence seizures shows characteristic **generalized 3-Hz spike-and-wave discharges**, not 4-second interval periodic discharges. *REM sleep disorder* - **REM sleep behavior disorder** involves the acting out of vivid dreams due to the absence of normal muscle atonia during REM sleep [1]. - EEG in REM sleep behavior disorder shows normal sleep architecture but may include evidence of **muscle activity (EMG)** during REM sleep, not periodic discharges [1]. *Focal epilepsy* - **Focal epilepsy** originates in a specific area of the brain, causing seizures with symptoms dependent on the affected region [2]. - EEG findings in focal epilepsy typically show **interictal spikes or sharp waves** localized to the region of seizure onset, which are distinct from generalized periodic discharges [2].

Q: Myasthenia gravis is an autoimmune disorder and antibodies against which of the following can cause the disease?

All of the options. ***All of the options*** - Myasthenia gravis is an autoimmune disease primarily characterized by antibodies against **acetylcholine receptors (AChR)**, which accounts for about 85% of cases [1]. - However, approximately 10% of patients have antibodies against **muscle-specific kinase (MuSK)**, and a smaller percentage (1-4%) have antibodies against **low-density lipoprotein receptor-related protein 4 (LRP4)**. *Low-density lipoprotein receptor-related protein 4 (LRP4)* - Antibodies against **LRP4** are found in a subset of myasthenia gravis patients, particularly those who are negative for both AChR and MuSK antibodies. - LRP4 is involved in the formation and maintenance of the **neuromuscular junction**, playing a crucial role in clustering AChRs. *Muscle specific kinase protein (MuSK)* - **MuSK antibodies** are present in 5-10% of myasthenia gravis patients, often presenting with a more focal weakness, particularly affecting bulbar and respiratory muscles. - MuSK is a receptor tyrosine kinase essential for developing and maintaining the postsynaptic specialization of the **neuromuscular junction**. *Acetylcholine receptors (AChR)* - **AChR antibodies** are the most common cause of myasthenia gravis, found in about 85% of patients [1]. - These antibodies block, modulate, or destroy **acetylcholine receptors** at the postsynaptic membrane of the neuromuscular junction, leading to impaired nerve-to-muscle transmission [1].

Q: Risk factors for Alzheimer's include:-

Down's syndrome. ***Down's syndrome*** - Individuals with **Down's syndrome** have an extra copy of chromosome 21, which includes the **amyloid precursor protein (APP) gene**. - Overexpression of APP leads to increased production of **beta-amyloid plaques**, a hallmark pathology of Alzheimer's disease. *Parkinson's disease* - Parkinson's disease is a **neurodegenerative disorder** characterized by motor symptoms due to loss of dopaminergic neurons. - While it can be associated with **dementia (Parkinson's disease dementia)**, it is a distinct condition with different primary pathological mechanisms (alpha-synucleinopathy). *Vascular dementia* - **Vascular dementia** is caused by brain damage from conditions that impair blood flow to the brain, such as strokes or small vessel disease. - It is a **different type of dementia** with distinct etiology and neuropathology compared to Alzheimer's disease. *Huntington's disease* - **Huntington's disease** is a genetic neurodegenerative disorder characterized by involuntary movements (**chorea**), cognitive decline, and psychiatric problems. - It is caused by a mutation in the **Huntingtin gene** and has a specific pathological course unrelated to Alzheimer's.

Q: A patient presented with clinical features of ataxia and incoordination. It is most likely due to involvement of which artery among the following.

Superior cerebellar. ***Superior cerebellar*** - The superior cerebellar artery supplies the **superior cerebellum**, which is critical for **coordination** and balance [1]. - Involvement of this artery commonly leads to **ataxia**, **dysarthria**, and **ipsilateral limb incoordination** [3]. *Middle cerebral* - The middle cerebral artery primarily supplies the **lateral surface of the cerebrum**, including motor and sensory cortices. - Strokes in this territory typically cause **contralateral hemiparesis**, **aphasia**, and **hemianopia**, not ataxia as a primary symptom [2]. *Posterior cerebellar* - The posterior cerebral artery supplies the **occipital lobe**, **thalamus**, and parts of the temporal lobe. - Occlusion often results in **visual field defects** (hemianopia), **memory deficits**, and sometimes **sensory loss**, but not isolated ataxia [2]. *Anterior cerebral* - The anterior cerebral artery supplies the **medial frontal and parietal lobes**. - Its occlusion typically causes **contralateral leg weakness** (hemiparesis), **behavioral changes**, and **urinary incontinence**.

Q: A 30-year-old shows delusions, hallucinations, and marked thought disorder. Labs reveal anti-NMDA receptor antibodies. Best initial treatment?

Immunotherapy. ***Immunotherapy*** - The presence of **anti-NMDA receptor antibodies** indicates an autoimmune etiology for the psychiatric symptoms, making **immunotherapy** (e.g., corticosteroids, IVIG, plasmapheresis) the definitive first-line treatment. - Immunotherapy aims to reduce inflammation and remove autoantibodies, thereby reversing the neurological and psychiatric manifestations. *Benzodiazepines* - While useful for acute agitation or catatonia in psychiatric disorders, **benzodiazepines** do not address the underlying autoimmune pathology of anti-NMDA receptor encephalitis. - They would provide only symptomatic relief and would not prevent disease progression or long-term neurological damage. *ECT* - **Electroconvulsive therapy (ECT)** is a treatment for severe, refractory mood disorders or catatonia, which might be present in anti-NMDA receptor encephalitis. - However, ECT is a symptomatic treatment and does not target the autoimmune cause, making it less appropriate as the **initial definitive treatment**. *Antipsychotics* - **Antipsychotics** are used to manage psychosis, delusions, and hallucinations, which are prominent in anti-NMDA receptor encephalitis. - However, they do not treat the underlying **autoimmune inflammation** and may worsen some symptoms, such as autonomic instability or seizures, in this specific condition.

Q: What is the most sensitive test for diagnosing carpal tunnel syndrome?

Nerve Conduction Study. ***Nerve Conduction Study*** - This test directly measures the speed and amplitude of electrical signals through the **median nerve**, which is compromised in carpal tunnel syndrome. [1] - NCS is considered the **gold standard** for diagnosing carpal tunnel syndrome due to its high sensitivity and specificity in detecting nerve compression. [1] *Hand Grip Strength* - While grip strength can be reduced in advanced cases of carpal tunnel syndrome, it is a **non-specific symptom** and not a sensitive diagnostic measure. [1] - Many conditions affecting the hand or arm can cause decreased grip strength, making it an unreliable primary diagnostic tool. *Phalen's Test* - This **provocative test** involves sustained wrist flexion, which can reproduce symptoms in many patients with carpal tunnel syndrome. - However, it has **variable sensitivity** and specificity; a negative test does not rule out CTS, and other wrist problems can produce a positive result. *Tinel's Sign* - This test involves **tapping over the median nerve** at the wrist to elicit tingling or pain, suggesting nerve irritation. - Similar to Phalen's test, it is a **provocative maneuver** with moderate sensitivity and specificity, and a positive result can occur in other conditions. [1]

Question 1

Rademecker complex in EEG is seen in -

Accepted Answer

SSPE

Answer

Kuru

Answer

cCJD

Answer

vCJD

Question 2

Herpes virus involves which lobe?

Accepted Answer

Temporal

Answer

Occipital

Answer

Parietal

Answer

Frontal

Question 3

Reversible dementia is seen in all EXCEPT:

Accepted Answer

Alzheimer's

Answer

Hypothyroidism

Answer

Wernicke's encephalopathy

Answer

Head trauma

Question 4

A 60-year old female presented with decreased movements for the last 2 years with rigidity and vertical large square wave jerks. The most likely diagnosis is?

Accepted Answer

Progressive supranuclear palsy

Answer

Parkinson's disease

Answer

Lewy body dementia

Answer

Multisystem atrophy

Question 5

Which condition is associated with periodic discharges on EEG at 4-second intervals?

Accepted Answer

SSPE

Answer

Absence Seizure

Answer

REM sleep disorder

Answer

Focal epilepsy

Question 6

Myasthenia gravis is an autoimmune disorder and antibodies against which of the following can cause the disease?

Accepted Answer

All of the options

Answer

Low-density lipoprotein receptor-related protein 4 (LRP4)

Answer

Muscle specific kinase protein (MuSK)

Answer

Acetylcholine receptors (AChR)

Question 7

Risk factors for Alzheimer's include:-

Accepted Answer

Down's syndrome

Answer

Parkinson's disease

Answer

Vascular dementia

Answer

Huntington's disease

Question 8

A patient presented with clinical features of ataxia and incoordination. It is most likely due to involvement of which artery among the following.

Accepted Answer

Superior cerebellar

Answer

Middle cerebral

Answer

Posterior cerebral

Answer

Anterior cerebral

Question 9

A 30-year-old shows delusions, hallucinations, and marked thought disorder. Labs reveal anti-NMDA receptor antibodies. Best initial treatment?

Accepted Answer

Immunotherapy

Answer

Benzodiazepines

Answer

ECT

Answer

Antipsychotics

Question 10

What is the most sensitive test for diagnosing carpal tunnel syndrome?

Accepted Answer

Nerve Conduction Study

Answer

Hand Grip Strength

Answer

Phalen's Test

Answer

Tinel's Sign

Neurology — MCQs

Neurology — MCQs

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