EMQs in Clinical Medicine.pdf - Peshawar Medical College

96 Neurology
There is marked loss of neurons in the caudate nucleus and putamen.
The patient usually presents in middle age with development of
chorea. The condition is progressive and dementia may occur in the
latter stages.
Tetrabenazine is often used to control the choreiform movements.
Sydenham’s chorea is a rare complication of rheumatic fever that
involves onset of choreiform movements later in life.
G
A
F
A 75-year-old man with poorly controlled diabetes is distressed by
wild flinging of his right arm and right leg.
Usually the underlying pathology is infarction/haemorrhage in the contralateral
subthalamic nucleus.
Grimacing and involuntary chewing in a 75-year-old woman on
long-term treatment with neuroleptics.
Tardive dyskinesia is a movement disorder that usually appears only
after long-term treatment with typical antipsychotic medications and
other drugs with dopamine antagonist activity, e.g. metoclopramide.
Withdrawal of the responsible drug can lead to improvement but the
condition is irreversible in some patients. Atypical antipsychotic
medications such as clozapine and risperidone are less likely to cause
extrapyramidal side effects and tardive dyskinesia.
Past-pointing in a 60-year-old woman being investigated for
unsteady gait.
Dysdiadochokinesis (incoordination of rapidly alternating movement),
nystagmus and intention tremor are signs of cerebellar disease that can
be easily elicited/observed at the bedside.
35 Neurological problems
Answers: J I H E D
J
A 45-year-old woman complains of a pain behind the right ear and
that her mouth is sagging on the right-hand side.
In a Bell’s palsy (lower motor neuron lesion affecting cranial nerve VII)
all the muscles on one half of the face are affected. There may also be
loss of taste sensation on the anterior two-thirds of the tongue because
the facial nerve supplies sensory innervation to that area via the chorda
tympani.
Improvement and complete recovery are common. EMG can often be a
good predictor of outcome. In an upper motor neuron lesion (caused by a
cerebrovascular accident or CVA, for example) there is sparing of the
forehead as a result of bilateral innervation. The patient will be able to
raise both eyebrows.