Neurology Practice Questions

Q: Which of the following features helps in distinguishing seizures from syncope?

Physical weakness with clear sensorium. ***Physical weakness with clear sensorium*** - This describes the **post-syncopal state**, where a patient typically feels weak but is fully aware and oriented immediately upon regaining consciousness, unlike the **post-ictal confusion** seen after a seizure [1]. - The rapid return to a clear sensorium is a key differentiating feature as syncope is a transient global cerebral hypoperfusion event without the sustained neuronal discharge of a seizure [1], [2]. *Urinary incontinence* - **Urinary incontinence** can occur in both severe syncopal episodes and seizures, making it a non-specific differentiator [1], [2]. - While more common and often tonic in seizures, brief bladder control loss can happen with significant hypotension in syncope. *Injury due to fall* - **Injury due to fall** can occur in both seizures and syncope, as both conditions involve a sudden loss of postural control [2]. - The nature of the injury might differ (e.g., specific injuries like posterior shoulder dislocation in seizures), but the fall itself is not distinctive. *Loss of consciousness* - Both **seizures** and **syncope** are characterized by a transient **loss of consciousness** [3]. - This symptom defines the core presentation of both conditions and therefore does not help in distinguishing between them.

Q: Which of the following sites is responsible for the amnestic defect in Wernicke-Korsakoff syndrome?

Mamillary body. ***Mamillary body*** - The **mamillary bodies** are the **classically recognized** anatomical substrate for the **amnestic defect** in Wernicke-Korsakoff syndrome due to their crucial role in the Papez circuit and memory formation. - Damage to these structures, caused by **thiamine deficiency**, severely impairs the ability to form new memories (anterograde amnesia) and recall past memories (retrograde amnesia). - Bilateral mamillary body lesions are consistently found in Wernicke-Korsakoff syndrome and correlate strongly with memory impairment. *Thalamus* - The **mediodorsal nucleus of the thalamus** is also critically involved in Wernicke-Korsakoff syndrome and plays a significant role in the memory deficit. - Modern research shows that thalamic damage (particularly mediodorsal nucleus) correlates strongly with amnesia severity and may contribute equally to the memory impairment. - However, **mamillary bodies** remain the **classic exam answer** when identifying the primary site for amnestic defects in this syndrome. *Subthalamic nucleus* - The **subthalamic nucleus** is primarily involved in **motor control** and is a key component of the basal ganglia circuit, not memory function. - Damage to this site is typically associated with movement disorders like **hemiballismus**, not amnesia. *Medial forebrain bundle* - The **medial forebrain bundle (MFB)** is a collection of nerve fibers connecting the brainstem, hypothalamus, and limbic areas, playing a role in **reward and motivation**. - While it contributes to overall brain function, it is not the primary site responsible for the amnestic defect in Wernicke-Korsakoff syndrome.

Q: Which of the following is a reversible cause of dementia? a) Post encephalitis b) Multi-infarct c) Hydrocephalus d) Senile dementia

Hydrocephalus. ***Hydrocephalus*** - **Normal pressure hydrocephalus (NPH)** is a classic **reversible cause of dementia**, characterized by the triad of **gait disturbance**, **urinary incontinence**, and **dementia** [1]. - Surgical intervention with a **ventriculoperitoneal shunt** can often improve or resolve the symptoms, making it a reversible condition. *Multi infarct* - **Multi-infarct dementia** is caused by multiple **small strokes** leading to damage in various brain regions. - The brain damage from these infarcts is generally **irreversible**, and while further strokes can be prevented, existing cognitive deficits typically do not resolve. *Senile dementia* - **Senile dementia** is a broad term often referring to **Alzheimer's disease** or other **neurodegenerative dementias** [1]. - These conditions are characterized by progressive and **irreversible brain degeneration**, leading to permanent cognitive decline. *Post encephalitis* - **Post-encephalitic cognitive impairment** can occur following severe brain inflammation (encephalitis) [1]. - While some recovery is possible, the resulting brain damage and associated cognitive deficits are often **permanent** or progressive, making it generally an irreversible cause of dementia.

Q: All except one constitute Benedict syndrome

Hemiparesis. Hemiparesis - Benedict syndrome, a midbrain injury, typically presents with ipsilateral oculomotor palsy, contralateral ataxia, and contralateral tremor. [3] - Hemiparesis is not a characteristic component of Benedict syndrome; it is more associated with lesions affecting the corticospinal tract. [1] Oculomotor palsy - Ipsilateral oculomotor palsy is a defining feature of Benedict syndrome resulting from damage to the oculomotor nerve nucleus or fascicles in the midbrain. [3], [4] - This typically presents as ptosis, dilated pupil, and eye deviation down and out. [5] Contralateral Ataxia - Contralateral ataxia is a key symptom caused by damage to the superior cerebellar peduncle as it decussates in the midbrain. - This leads to discoordination and an unsteady gait on the side opposite the midbrain lesion. [2] Tremors - Contralateral tremors, particularly rubral or intention tremors, are characteristic of Benedict syndrome. [2] - These tremors result from disruption of pathways involving the dentatorubrothalamic tract or its connections in the midbrain.

Q: The commonest cause of unilateral internuclear ophthalmoplegia is:

Multiple sclerosis. Multiple sclerosis - Multiple sclerosis (MS) is the **commonest cause** of **unilateral internuclear ophthalmoplegia (INO)**, especially in younger adults. - INO results from demyelination of the **medial longitudinal fasciculus (MLF)**, a common site for MS lesions. *Diabetes mellitus* - While diabetes can cause various neurological complications, **oculomotor neuropathies** associated with diabetes more often present as complete or incomplete **cranial nerve palsies**, not typically isolated INO. - These neuropathies usually affect the **third, fourth, or sixth cranial nerves** and are often painful. *Lead toxicity* - Lead toxicity can cause a variety of neurological symptoms, including **peripheral neuropathy** and **encephalopathy**. - However, it is not a recognized cause of isolated INO. *Hypertension* - Hypertension is a significant risk factor for **stroke**, which can cause INO if the infarct affects the **brainstem** and damages the MLF. - However, in cases of **unilateral INO**, particularly in the absence of other stroke symptoms, MS is a more frequent cause than a single hypertensive event.

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.

Question 1

Which of the following features helps in distinguishing seizures from syncope?

Accepted Answer

Physical weakness with clear sensorium

Answer

Urinary incontinence

Answer

Injury due to fall

Answer

Loss of consciousness

Question 2

Which of the following sites is responsible for the amnestic defect in Wernicke-Korsakoff syndrome?

Accepted Answer

Mamillary body

Answer

Thalamus

Answer

Subthalamic nucleus

Answer

Medial forebrain bundle

Question 3

Which of the following is a reversible cause of dementia?  
a) Post encephalitis  
b) Multi-infarct  
c) Hydrocephalus  
d) Senile dementia

Accepted Answer

Hydrocephalus

Answer

Multi infarct

Answer

Senile dementia

Answer

Post encephalitis

Question 4

Which of the following is true about trigeminal neuralgia?

Accepted Answer

Carbamazepine is the drug of choice in trigeminal neuralgia.

Answer

Can be treated with NSAID's

Answer

Is a hereditary condition

Answer

Always bilateral in distribution

Question 5

All except one constitute Benedict syndrome

Accepted Answer

Hemiparesis

Answer

Oculomotor palsy

Answer

Contralateral Ataxia

Answer

Tremors

Question 6

The commonest cause of unilateral internuclear ophthalmoplegia is:

Accepted Answer

Multiple sclerosis

Answer

Diabetes mellitus

Answer

Lead toxicity

Answer

Hypertension

Question 7

Rademecker complex in EEG is seen in -

Accepted Answer

SSPE

Answer

Kuru

Answer

cCJD

Answer

vCJD

Question 8

Herpes virus involves which lobe?

Accepted Answer

Temporal

Answer

Occipital

Answer

Parietal

Answer

Frontal

Question 9

Reversible dementia is seen in all EXCEPT:

Accepted Answer

Alzheimer's

Answer

Hypothyroidism

Answer

Wernicke's encephalopathy

Answer

Head trauma

Question 10

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

Neurology — MCQs

Neurology — MCQs

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