Neurology — MCQs
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A 73-year-old woman is admitted with acute left hemiparesis. CT shows a right middle cerebral artery territory infarct with significant oedema. Over 24 hours she becomes increasingly drowsy with a GCS of 10. Repeat CT shows increasing midline shift and early uncal herniation. Blood pressure is 168/96 mmHg. What is the most appropriate management?
A 61-year-old man with hypertension and hyperlipidaemia presents 36 hours after sudden onset right arm weakness and dysphasia that lasted 2 hours and fully resolved. CT head shows no acute changes. Carotid Doppler shows 55% stenosis of the left internal carotid artery. His ABCD² score is 5. What is the most appropriate management regarding antiplatelet therapy?
A 38-year-old woman presents to the Emergency Department with sudden onset 'worst ever' headache that reached maximum intensity within seconds while lifting weights at the gym. She has photophobia and neck stiffness. CT head performed 8 hours after symptom onset is reported as normal. What is the most appropriate next investigation?
A 65-year-old man with progressive cognitive decline over 18 months presents with recurrent detailed visual hallucinations of people in his house, marked fluctuations in alertness during the day, and spontaneous parkinsonian features with rigidity and bradykinesia. CT head shows generalised atrophy. What is the most likely diagnosis?
A 47-year-old woman presents with episodic severe right periorbital pain lasting 45-60 minutes, occurring 2-3 times daily for the past 2 weeks. During attacks she has right-sided lacrimation, conjunctival injection and nasal congestion. Between attacks she is completely well. What is the most appropriate acute treatment for individual attacks?
A 76-year-old woman with Alzheimer's dementia (MMSE 16/30) has progressive functional decline. She lives alone and was found by neighbours having not eaten for several days. Her daughter reports she leaves the gas cooker on and has gotten lost twice in familiar places. What is the most appropriate next step in her management?
A 29-year-old man with newly diagnosed focal epilepsy is started on antiepileptic medication. He should be advised to inform the DVLA and stop driving. After what minimum seizure-free period can he reapply for a Group 1 (car) driving licence if seizures are controlled with medication?
A 56-year-old woman presents with a 6-hour history of right arm weakness, dysarthria and right facial droop. CT head shows no haemorrhage but an established left basal ganglia infarct from 2 years ago. MRI shows acute left middle cerebral artery territory infarction and vessel imaging shows 90% left internal carotid artery stenosis. What is the most appropriate timing for carotid intervention?
An 82-year-old man in the stroke unit develops sudden agitation, visual hallucinations of small animals, and disorientation 48 hours after admission for ischaemic stroke. He is apyrexial. Observations show oxygen saturation 94% on room air, pulse 88/min regular, BP 142/84 mmHg. What is the most appropriate initial investigation?
A 43-year-old woman describes episodes of seeing flashing zigzag lines in both visual fields lasting 20 minutes, followed by severe unilateral throbbing headache, nausea and photophobia lasting 8 hours. She has 2-3 episodes monthly. Which prophylactic medication is contraindicated if she has a history of depression and asthma?
Neurology UK Medical PG Practice Questions and MCQs
Question 81: A 73-year-old woman is admitted with acute left hemiparesis. CT shows a right middle cerebral artery territory infarct with significant oedema. Over 24 hours she becomes increasingly drowsy with a GCS of 10. Repeat CT shows increasing midline shift and early uncal herniation. Blood pressure is 168/96 mmHg. What is the most appropriate management?
- A. Urgent referral to neurosurgery for decompressive hemicraniectomy (Correct Answer)
- B. Intravenous mannitol and maintain head elevation
- C. Controlled blood pressure reduction to target 140/90 mmHg
- D. Intravenous dexamethasone 8mg four times daily
- E. Intubation and hyperventilation to target PaCO2 4.0-4.5 kPa
Explanation: ***Urgent referral to neurosurgery for decompressive hemicraniectomy*** - This patient presents with rapidly worsening neurological status (decreasing GCS), evidence of **malignant middle cerebral artery (MCA) infarction** with significant **oedema**, increasing **midline shift**, and early **uncal herniation**. - **Decompressive hemicraniectomy** is the most effective treatment for large hemispheric strokes causing mass effect and impending herniation, significantly reducing mortality and improving functional outcomes in eligible patients. *Intravenous mannitol and maintain head elevation* - While **mannitol** and head elevation are initial **medical strategies** to reduce **intracranial pressure (ICP)**, they are temporizing measures and often insufficient for severe, progressive mass effect and mechanical herniation. - These interventions provide symptomatic relief but do not address the underlying expansive lesion causing the **malignant brain swelling**. *Controlled blood pressure reduction to target 140/90 mmHg* - Lowering blood pressure aggressively in an acute ischemic stroke with **raised ICP** can compromise **cerebral perfusion pressure (CPP)**, potentially extending the ischemic injury in the penumbra. - Current guidelines generally recommend maintaining a higher blood pressure in acute ischemic stroke to ensure adequate cerebral perfusion, especially in the absence of thrombolysis, unless BP is excessively high (e.g., >220/120 mmHg). *Intravenous dexamethasone 8mg four times daily* - **Corticosteroids** like dexamethasone are effective for **vasogenic edema** associated with tumors or infections, but they are not beneficial for **cytotoxic edema** seen in ischemic stroke and can even worsen outcomes. - Steroids can increase the risk of complications such as hyperglycemia and infection in stroke patients without improving neurological recovery. *Intubation and hyperventilation to target PaCO2 4.0-4.5 kPa* - **Hyperventilation** acutely lowers ICP by causing **cerebral vasoconstriction** due to reduced PaCO2, but its effect is transient and can lead to **secondary ischemia** by reducing cerebral blood flow to critical areas. - This measure is typically reserved as a very short-term bridge to definitive surgical intervention or in cases of acute, life-threatening ICP elevation, and sustained use is discouraged due to risks.
Question 82: A 61-year-old man with hypertension and hyperlipidaemia presents 36 hours after sudden onset right arm weakness and dysphasia that lasted 2 hours and fully resolved. CT head shows no acute changes. Carotid Doppler shows 55% stenosis of the left internal carotid artery. His ABCD² score is 5. What is the most appropriate management regarding antiplatelet therapy?
- A. Aspirin 300mg loading dose then clopidogrel 75mg daily
- B. Aspirin 300mg daily alone for 2 weeks then clopidogrel 75mg daily
- C. Aspirin 300mg loading dose then aspirin 75mg plus clopidogrel 75mg daily for 21 days, then clopidogrel alone (Correct Answer)
- D. Clopidogrel 300mg loading dose then 75mg daily alone
- E. Start warfarin with target INR 2-3
Explanation: ***Aspirin 300mg loading dose then aspirin 75mg plus clopidogrel 75mg daily for 21 days, then clopidogrel alone*** - For high-risk **Transient Ischaemic Attack (TIA)** defined by an **ABCD² score ≥4** or minor stroke, current clinical practice (based on **POINT/CHANCE trials**) recommends immediate **Dual Antiplatelet Therapy (DAPT)**. - **DAPT** for the first **21 days** significantly reduces the risk of early stroke recurrence compared to monotherapy, followed by long-term **clopidogrel** monotherapy. *Aspirin 300mg loading dose then clopidogrel 75mg daily* - This regimen constitutes an immediate switch to **clopidogrel monotherapy**, which is less effective than **DAPT** in preventing recurrent events during the first 3 weeks. - It fails to utilize the synergistic effect of both antiplatelets during the period of highest risk following a **TIA**. *Aspirin 300mg daily alone for 2 weeks then clopidogrel 75mg daily* - Previous guidelines used **aspirin monotherapy** until carotid imaging, but modern evidence favors **DAPT** for patients with high-risk clinical scores. - Using only one agent does not provide optimal protection for a patient with an **ABCD² score of 5** and significant **carotid stenosis**. *Clopidogrel 300mg loading dose then 75mg daily alone* - While **clopidogrel** is the standard for long-term secondary prevention, it is not recommended as a solo loading agent for acute **TIA** management in the absence of contraindications to aspirin. - Evidence specifically supports the combination of **aspirin and clopidogrel** to quickly stabilize the prothrombotic state in high-risk patients. *Start warfarin with target INR 2-3* - **Warfarin** or other anticoagulants are indicated for secondary prevention only if there is a diagnosed **cardioembolic source**, such as **atrial fibrillation**. - This patient's symptoms are likely due to **large artery atherosclerosis** (carotid stenosis), for which **antiplatelet therapy** is the appropriate pharmacological intervention.
Question 83: A 38-year-old woman presents to the Emergency Department with sudden onset 'worst ever' headache that reached maximum intensity within seconds while lifting weights at the gym. She has photophobia and neck stiffness. CT head performed 8 hours after symptom onset is reported as normal. What is the most appropriate next investigation?
- A. Repeat CT head in 24 hours
- B. Lumbar puncture with spectrophotometry for xanthochromia (Correct Answer)
- C. CT angiography of cerebral vessels
- D. MRI brain with gadolinium contrast
- E. No further investigation required as CT was normal
Explanation: ***Lumbar puncture with spectrophotometry for xanthochromia***- This patient presents with classic symptoms of **subarachnoid haemorrhage (SAH)**: sudden onset 'worst ever' headache (thunderclap headache), photophobia, and neck stiffness, especially after exertion.- Even with a normal CT head, if the scan was performed more than 6 hours after symptom onset (here, 8 hours), its sensitivity for SAH decreases. A **lumbar puncture (LP)** for **xanthochromia** is crucial to definitively rule out SAH in such high-suspicion cases, typically performed 12 hours post-onset to allow for bilirubin formation.*Repeat CT head in 24 hours*- The sensitivity of non-contrast CT for SAH **decreases significantly** after 6-12 hours due to blood dilution and resorption.- Repeating a CT scan would further delay the definitive diagnosis and is unlikely to yield new information if the initial scan was already negative beyond the acute window.*CT angiography of cerebral vessels*- **CT angiography (CTA)** is used to identify the **source of bleeding**, such as an aneurysm, after SAH has been confirmed.- It is not a primary diagnostic tool to confirm the presence of SAH itself when initial imaging is equivocal, but rather a follow-up test once SAH is diagnosed.*MRI brain with gadolinium contrast*- While MRI can detect subarachnoid blood, especially with specific sequences, it is generally **less readily available** and **not the first-line investigation** for acute SAH in the emergency setting compared to CT or LP.- For suspected SAH with a negative CT performed late, **lumbar puncture** remains the gold standard for ruling out blood in the CSF.*No further investigation required as CT was normal*- Given the classic presentation of a **thunderclap headache** and the timing of the CT (8 hours post-onset), a normal CT does not reliably exclude SAH due to its **reduced sensitivity** beyond 6 hours.- Discharging the patient without further investigation would be a **high-risk decision** given the potentially life-threatening nature of SAH.
Question 84: A 65-year-old man with progressive cognitive decline over 18 months presents with recurrent detailed visual hallucinations of people in his house, marked fluctuations in alertness during the day, and spontaneous parkinsonian features with rigidity and bradykinesia. CT head shows generalised atrophy. What is the most likely diagnosis?
- A. Dementia with Lewy bodies (Correct Answer)
- B. Alzheimer's dementia with parkinsonian features
- C. Parkinson's disease with dementia
- D. Vascular dementia with lacunar infarcts
- E. Progressive supranuclear palsy
Explanation: ***Dementia with Lewy bodies*** - This patient presents with **progressive cognitive decline**, **recurrent detailed visual hallucinations**, **marked fluctuations in alertness**, and **spontaneous parkinsonian features** (rigidity, bradykinesia), which is the classic diagnostic tetrad. - The co-occurrence of these specific symptoms points strongly towards **Dementia with Lewy bodies (DLB)**, distinguishing it from other neurodegenerative conditions. *Alzheimer's dementia with parkinsonian features* - **Alzheimer's dementia** primarily manifests with early and prominent **episodic memory loss**, followed by other cognitive deficits. Parkinsonian features are usually a **late complication**. - The striking visual hallucinations and marked fluctuations in alertness are **atypical** as early or core features of Alzheimer's disease. *Parkinson's disease with dementia* - This diagnosis requires that **motor symptoms of Parkinson's disease** must precede the onset of dementia by **at least one year** (the "1-year rule"). - In this case, the cognitive decline and parkinsonian features seem to have a more concurrent or closely timed onset, making **DLB** a more fitting diagnosis. *Vascular dementia with lacunar infarcts* - **Vascular dementia** is typically characterized by a **stepwise decline** in cognitive function or a clear association with **cerebrovascular events**. - While generalized atrophy is present, the specific combination of visual hallucinations, fluctuations, and parkinsonism is **not characteristic** of vascular dementia. *Progressive supranuclear palsy* - **Progressive supranuclear palsy (PSP)** is defined by early and frequent **falls** due to postural instability, **vertical supranuclear gaze palsy**, and **axial rigidity**. - Recurrent detailed visual hallucinations and marked fluctuations in alertness are **not typical** features of PSP.
Question 85: A 47-year-old woman presents with episodic severe right periorbital pain lasting 45-60 minutes, occurring 2-3 times daily for the past 2 weeks. During attacks she has right-sided lacrimation, conjunctival injection and nasal congestion. Between attacks she is completely well. What is the most appropriate acute treatment for individual attacks?
- A. Subcutaneous sumatriptan 6mg or high-flow oxygen 100% 12-15 L/min (Correct Answer)
- B. Oral sumatriptan 50mg
- C. Oral prednisolone 60mg
- D. Indomethacin 75mg three times daily
- E. Oral paracetamol 1g with codeine 30mg
Explanation: ***Subcutaneous sumatriptan 6mg or high-flow oxygen 100% 12-15 L/min*** - This patient exhibits classic **cluster headache** features, including severe unilateral periorbital pain and **ipsilateral autonomic symptoms** (lacrimation, nasal congestion). - **High-flow oxygen** and **subcutaneous sumatriptan** are the first-line acute treatments because they provide the rapid onset of action required for short-duration attacks. *Oral sumatriptan 50mg* - **Oral triptans** have a slow onset of action (typically 30–60 minutes), which is ineffective for attacks that peak and often resolve quickly. - **Subcutaneous** or nasal routes are preferred to ensure the medication works before the cluster headache attack naturally ends. *Oral prednisolone 60mg* - **Prednisolone** is used as a **transitional prophylactic** treatment to reduce the frequency of attacks during a cluster period. - It does not work quickly enough to provide relief for an **acute individual attack** occurring in real-time. *Indomethacin 75mg three times daily* - This is the pathognomonic treatment for **paroxysmal hemicrania**, which presents with shorter, more frequent attacks (typically >5 per day). - **Cluster headaches** do not show the same dramatic, diagnostic response to **indomethacin** that other trigeminal autonomic cephalalgias do. *Oral paracetamol 1g with codeine 30mg* - Simple analgesics and **opioid combinations** are generally ineffective for the severe, penetrating pain associated with **cluster headaches**. - Relying on codeine increases the risk of **medication overuse headache** without addressing the underlying pathophysiology of the attack.
Question 86: A 76-year-old woman with Alzheimer's dementia (MMSE 16/30) has progressive functional decline. She lives alone and was found by neighbours having not eaten for several days. Her daughter reports she leaves the gas cooker on and has gotten lost twice in familiar places. What is the most appropriate next step in her management?
- A. Arrange urgent social services assessment for care package and consider safeguarding (Correct Answer)
- B. Increase her cholinesterase inhibitor dose
- C. Arrange direct admission to a nursing home
- D. Refer to psychiatry for compulsory admission under Mental Health Act
- E. Prescribe antipsychotic medication to improve orientation
Explanation: ***Arrange urgent social services assessment for care package and consider safeguarding*** - The patient is at significant risk of **self-neglect** (malnutrition, gas hazards) and physical harm (getting lost), necessitating an immediate evaluation of her **safety** and living environment. - An urgent assessment allows for the implementation of a professional **care package** or potential transition to a safer living setting, while addressing **safeguarding** concerns due to her vulnerability and inability to care for herself. *Increase her cholinesterase inhibitor dose* - While cholinesterase inhibitors are used in **Alzheimer's dementia** to manage cognitive symptoms, increasing the dose will not address the immediate and life-threatening **safety risks** identified. - Medication adjustments focus on cognitive symptom management rather than solving acute **functional decline** or environmental hazards that pose an immediate risk. *Arrange direct admission to a nursing home* - Direct admission to a nursing home without a formal **needs assessment** or a **mental capacity assessment** bypasses legal and ethical protocols, particularly the principle of the 'least restrictive' option. - **Social services** must first evaluate if the patient can be supported at home with a care package before considering permanent institutionalization, especially without clear evidence of her wishes or capacity. *Refer to psychiatry for compulsory admission under Mental Health Act* - The **Mental Health Act** is generally used for acute psychiatric crises or risks resulting from a severe mental disorder where detention is necessary for the patient's or others' safety, not primarily for long-term **dementia care** and placement issues. - The primary issue here is **social care** and capacity for independent living, which is better managed under a framework like the **Mental Capacity Act** in conjunction with social services, focusing on her best interests. *Prescribe antipsychotic medication to improve orientation* - Antipsychotics do not improve **orientation** or general cognitive function in dementia; they are primarily used for severe **behavioral and psychological symptoms of dementia (BPSD)** such as aggression, hallucinations, or delusions. - These medications carry significant risks in elderly patients with dementia, including an increased risk of **stroke**, **cardiac events**, and **mortality**, and should only be used judiciously for specific indications.
Question 87: A 29-year-old man with newly diagnosed focal epilepsy is started on antiepileptic medication. He should be advised to inform the DVLA and stop driving. After what minimum seizure-free period can he reapply for a Group 1 (car) driving licence if seizures are controlled with medication?
- A. 12 months (Correct Answer)
- B. 6 months
- C. 3 months
- D. 24 months
- E. 5 years
Explanation: ***12 months***- **DVLA (Driver and Vehicle Licensing Agency)** regulations stipulate a **minimum seizure-free period of 12 months** for individuals with a newly diagnosed or recurrent epileptic seizure to reapply for a **Group 1 (car)** driving licence.- This period ensures a sufficient duration of **seizure control** to mitigate the risk of recurrence while driving, even when seizures are managed with **antiepileptic medication**.*6 months*- A **6-month seizure-free period** is generally not sufficient for reapplication for a Group 1 licence after a diagnosis of **epilepsy**.- This shorter period might apply in very specific circumstances, such as a **single isolated unprovoked seizure** with normal investigations, but not for an established diagnosis of **focal epilepsy**.*3 months*- A **3-month seizure-free period** is significantly shorter than the required duration by the **DVLA** for patients with epilepsy.- This period does not provide adequate evidence of **sustained seizure control** to ensure public safety on the road.*24 months*- While a longer seizure-free period is always better, **24 months** is not the *minimum* required period for a **Group 1 (car)** driving licence after controlled epilepsy.- The **12-month** mark is the established minimum for reapplication, assuming sustained control and medical fitness to drive.*5 years*- A **5-year seizure-free period** is a requirement for certain **Group 2 (lorry/bus)** driving licences, which have much stricter medical standards due to the nature of the vehicles and the potential for greater harm.- It is not the minimum requirement for a standard **Group 1 (car or motorcycle)** licence.
Question 88: A 56-year-old woman presents with a 6-hour history of right arm weakness, dysarthria and right facial droop. CT head shows no haemorrhage but an established left basal ganglia infarct from 2 years ago. MRI shows acute left middle cerebral artery territory infarction and vessel imaging shows 90% left internal carotid artery stenosis. What is the most appropriate timing for carotid intervention?
- A. Within 48 hours of symptom onset (Correct Answer)
- B. After 2 weeks but within 3 months
- C. After 6 months to allow stroke stabilisation
- D. Carotid intervention is contraindicated due to previous stroke
- E. Immediately in the emergency department
Explanation: ***Within 48 hours of symptom onset*** - This is the **most appropriate timing** for carotid intervention in patients with symptomatic, severe carotid stenosis (70-99%) who have experienced a minor or moderate stroke. - Evidence suggests that intervening **early (ideally within 48 hours, and definitely within 2 weeks)** significantly reduces the risk of recurrent ischemic stroke, which is highest in the immediate post-stroke period. *After 2 weeks but within 3 months* - Delaying carotid intervention beyond **two weeks** after a symptomatic event substantially diminishes the benefit, as the risk of **recurrent stroke** decreases significantly after this initial high-risk period. - While still within the window for some benefit, the **optimal window** for maximal risk reduction has passed, and patients are exposed to unnecessary risk during the waiting period. *After 6 months to allow stroke stabilisation* - Such a prolonged delay is **not recommended** for symptomatic severe carotid stenosis as it misses the critical window for **secondary stroke prevention**. - The rationale for waiting is typically applied to very severe or disabling strokes where the risk of **perioperative complications** outweighs early benefits, which is not described in this case. *Carotid intervention is contraindicated due to previous stroke* - A **prior stable stroke** (like the 2-year-old left basal ganglia infarct) is not a contraindication to carotid intervention, especially when there's an acute, **symptomatic severe stenosis** in a different territory. - The intervention is aimed at preventing further **ischemic events** in the territory supplied by the critically stenosed ICA, not treating the old infarct. *Immediately in the emergency department* - Carotid intervention (endarterectomy or stenting) is an elective procedure that requires **pre-operative assessment**, including a detailed neurological evaluation and optimization of medical management. - While urgent, it is typically performed in an **operating room** or interventional suite and not immediately upon arrival in the emergency department like thrombolysis or mechanical thrombectomy.
Question 89: An 82-year-old man in the stroke unit develops sudden agitation, visual hallucinations of small animals, and disorientation 48 hours after admission for ischaemic stroke. He is apyrexial. Observations show oxygen saturation 94% on room air, pulse 88/min regular, BP 142/84 mmHg. What is the most appropriate initial investigation?
- A. Urinalysis and urine culture
- B. Repeat CT head
- C. Blood glucose measurement (Correct Answer)
- D. Chest X-ray
- E. Serum calcium and thyroid function tests
Explanation: ***Blood glucose measurement*** - Sudden onset of **delirium** (agitation, visual hallucinations, and disorientation) in an elderly patient, particularly post-stroke, mandates immediate exclusion of **hypoglycaemia**. - This is a rapid, reversible cause of neurological dysfunction that can be quickly identified and treated at the bedside, preventing further **neurological damage**. *Urinalysis and urine culture* - While **Urinary Tract Infections (UTIs)** are a common cause of delirium in the elderly, this patient is **apyrexial** and has stable vital signs, making it less urgent as an initial investigation. - This investigation should follow the exclusion of acute, life-threatening metabolic emergencies like **hypoglycaemia**. *Repeat CT head* - A repeat CT head primarily looks for **haemorrhagic transformation**, **cerebral oedema**, or a new stroke, which are typically indicated by new focal neurological deficits. - It is not the most appropriate *initial* bedside investigation for acute mental status changes without specific neurological signs warranting immediate imaging. *Chest X-ray* - A **Chest X-ray** is indicated to rule out pulmonary infections like **aspiration pneumonia**, which can cause delirium, especially in stroke patients. - However, the patient's oxygen saturation (94% on room air) is reasonable, and checking **blood glucose** takes immediate priority for acute mental status changes. *Serum calcium and thyroid function tests* - These tests are important for a comprehensive delirium workup to identify chronic or subacute metabolic disturbances like **hypercalcaemia** or **thyroid dysfunction**. - However, their results are not immediately available, and the clinical presentation of sudden, acute delirium prioritizes rapid bedside tests for reversible causes.
Question 90: A 43-year-old woman describes episodes of seeing flashing zigzag lines in both visual fields lasting 20 minutes, followed by severe unilateral throbbing headache, nausea and photophobia lasting 8 hours. She has 2-3 episodes monthly. Which prophylactic medication is contraindicated if she has a history of depression and asthma?
- A. Propranolol (Correct Answer)
- B. Amitriptyline
- C. Topiramate
- D. Candesartan
- E. Sodium valproate
Explanation: ***Propranolol***- **Propranolol** is a non-selective **beta-blocker** that is contraindicated in patients with **asthma** as it can cause life-threatening **bronchospasm** by blocking beta-2 receptors in the lungs.- It is also generally avoided in patients with a history of **depression**, as beta-blockers have been associated with worsening of depressive symptoms and lethargy.*Amitriptyline*- This **tricyclic antidepressant** is often a preferred choice for migraine prophylaxis in patients with comorbid **depression** or insomnia.- It does not cause bronchoconstriction and is safe for use in patients with **asthma**.*Topiramate*- **Topiramate** is an effective prophylactic agent, but it is primarily cautioned against in patients with **glaucoma** or a history of **kidney stones**.- While it can occasionally cause **mood disturbances** or cognitive slowing, it is not contraindicated by **asthma**.*Candesartan*- This **angiotensin II receptor blocker (ARB)** is an alternative second-line therapy for migraine prophylaxis with a favorable side effect profile.- It has no known adverse interactions with **asthma** or **depression**, making it a safe option for this patient.*Sodium valproate*- **Sodium valproate** is used for migraine prevention but is strictly avoided in **women of childbearing potential** due to its high **teratogenic risk**.- It does not worsen **asthma** or **depression**, although it may cause weight gain and liver enzyme elevations.
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