Neurology Practice Questions

Q: All of the following factors are associated with a substantially greater risk of developing epilepsy after febrile seizures, except:

Early age of onset. ***Early age of onset*** - While earlier onset of febrile seizures (e.g., before 12 months) is associated with an increased risk of *recurrence* of febrile seizures, it is **not independently a strong predictor** of developing epilepsy after febrile seizures compared to the other factors listed. - The age range for febrile seizures is typically 6 months to 5 years, and seizures within this range, regardless of earlier or later, carry similar baseline risks for subsequent epilepsy. *Complex Febrile seizures* - **Complex febrile seizures** (defined by duration >15 minutes, focal features, or multiple seizures within 24 hours) are a significant risk factor for developing later **epilepsy**, particularly temporal lobe epilepsy. - These features suggest a more significant underlying neurological predisposition or injury. *Developmental abnormalities* - Pre-existing **developmental abnormalities** or neurological deficits (e.g., cerebral palsy, developmental delay) are strong predictors of developing **epilepsy** after febrile seizures. - This indicates a vulnerable brain that is more susceptible to abnormal electrical activity. *Positive family History of Epilepsy* - A **positive family history of epilepsy** in a first-degree relative substantially increases the risk of an individual with febrile seizures developing later **epilepsy**. - This suggests a genetic predisposition to seizure disorders.

Q: A 4-year old child c/o inability to walk which was first noticed about two months back and worsened gradually. There is no history of fever or injury. There is a history of stress incontinence. On examination child has paraplegia and the anus is patulous. Reflexes are diminished and planters are flexor. There is loss of sensation below umbilicus. The segmental level of lesion is:

T 12. ***T 12*** - A loss of sensation below the **umbilicus** indicates a lesion at or above the **T10 dermatome**. - **Paraplegia**, stress incontinence (suggesting bladder dysfunction), and a **patulous anus** (indicating loss of anal sphincter tone) point to a lesion affecting the **conus medullaris** or lower thoracic spinal cord segments, with T12 being the most appropriate level given the symptom complex. *T 6* - A lesion at **T6** would typically result in a sensory level around the **nipple line**, which is much higher than the observed loss below the umbilicus. - This level would also likely present with more profound autonomic dysfunction and spasticity rather than diminished reflexes in the lower extremities. *T 10* - A lesion at **T10** would result in a sensory loss extending approximately to the region of the **xiphoid process** or just below, which is still higher than the umbilical level. - While it's close, the full symptom picture including bladder and bowel dysfunction strongly indicates a lesion affecting the lower thoracic or lumbar spine, consistent with T12. *T 8* - A lesion at **T8** would typically cause sensory loss around the **inframammary fold** or upper abdomen, which is significantly higher than the reported sensory level below the umbilicus. - This level is inconsistent with the pattern of sensory deficit described.

Q: Moro's reflex persisting for more than 6 months indicates damage to which of the following lobes?

Frontal. ***Frontal*** - Persistence of primitive reflexes such as the **Moro reflex** beyond 6 months suggests **delayed cortical maturation** and failure of cortical inhibition. - The **frontal lobe** and its connections via the **corticospinal tract** play a key role in suppressing brainstem-mediated primitive reflexes as the CNS matures. - While persistence often indicates **generalized CNS dysfunction** (e.g., cerebral palsy, developmental delay), among cortical lobes, the frontal lobe's motor and inhibitory functions make it most relevant to reflex suppression. *Temporal* - The temporal lobe is primarily involved in **auditory processing**, **memory formation**, and **language comprehension**. - Damage typically presents with **aphasia**, **auditory deficits**, or **memory impairment**, not persistent primitive reflexes. *Occipital* - The occipital lobe is responsible for **visual processing** and **visual perception**. - Lesions result in **visual field defects**, **cortical blindness**, or **visual agnosia**, not reflex abnormalities. *Parietal* - The parietal lobe integrates **sensory information** and is involved in **spatial awareness** and **body sensation**. - Damage leads to **sensory deficits**, **neglect syndromes**, or **apraxia**, not persistence of primitive reflexes.

Q: A young child with recurrent bacterial meningitis should be clinically evaluated for the presence of

Spina bifida occulta with a dermal sinus tract. ***Spina bifida occulta with a dermal sinus tract*** - A **dermal sinus tract** provides a direct pathway for skin flora to access deeper structures, including the **meninges**, leading to recurrent bacterial meningitis - This condition arises from incomplete closure of the neural tube and is often associated with cutaneous stigmata such as a **dimple, tuft of hair, or hemangioma** in the lumbosacral region - Clinical examination should focus on the **midline back** for these telltale signs - This is the **most common anatomical cause** of recurrent bacterial meningitis in children *Hypoplastic left heart syndrome* - This is a congenital heart defect resulting in an underdeveloped left side of the heart, leading to cyanosis and heart failure - It is not directly associated with an increased risk of recurrent bacterial meningitis - This is a **cardiac anomaly**, not a CNS communication defect *Syringomyelia of the lower cervical cord* - Syringomyelia involves the formation of a fluid-filled cavity (syrinx) within the spinal cord, typically causing neurological deficits related to pain, temperature sensation, and motor weakness - While it is a neurological condition, it does **not disrupt the meningeal barrier** and therefore does not explain recurrent bacterial meningitis - This is an **intramedullary lesion** without external communication *Holoprosencephaly* - This is a severe condition where the forebrain fails to develop into two hemispheres, leading to various craniofacial anomalies and significant neurological impairment - It is a developmental brain abnormality and is **not a cause** of recurrent bacterial meningitis - While severe, it does not create a pathway for bacterial entry into the CNS

Q: Which of the following is a FALSE statement regarding Cerebral Palsy?

Birth trauma is the most common cause of cerebral palsy. ***Birth trauma is the most common cause of cerebral palsy*** - While birth trauma can contribute to brain injury, **prematurity** and **intrauterine growth restriction** are actually more frequent risk factors for cerebral palsy. - The majority of cerebral palsy cases originate from prenatal or perinatal events, with **birth asphyxia** being a less common cause than historically believed. *Cerebral palsy occurs due to one time insult to developing fetal brain* - Cerebral palsy is defined by a **non-progressive disturbance** in the developing fetal or infant brain, which is indeed a "one time insult" rather than a degenerative process. - This insult can occur before, during, or shortly after birth, leading to permanent but **non-worsening** motor impairments. *Periventricular leucomalacia causes spastic diplegia* - **Periventricular leucomalacia (PVL)**, a type of white matter brain injury, is strongly associated with **spastic diplegia**, particularly in premature infants. - PVL damages the periventricular white matter that contains descending motor tracts to the lower limbs, hence causing a **diplegic** (legs more affected than arms) presentation. *Persistent cortical thumb after 3 months of age is seen in spastic cerebral palsy* - A **cortical thumb**, where the thumb is held adducted and flexed across the palm, can be a sign of **upper motor neuron lesion** or spasticity. - Its persistence beyond 3 months of age is an indicator of neurological dysfunction and is often observed in infants who develop **spastic cerebral palsy**.

Q: A child presented to the casualty with seizures. On examination multiple oval hypo-pigmented macules were noted on the trunk, along with sub-normal IQ. Probable diagnosis of the child is:

Tuberous Sclerosis. ***Tuberous Sclerosis*** - The combination of **seizures**, **hypopigmented macules** (ash-leaf spots), and **subnormal IQ** (intellectual disability) is highly characteristic of tuberous sclerosis. - Tuberous sclerosis is an **autosomal dominant neurocutaneous disorder** causing benign tumor growth in various organs, including the brain, skin, and kidneys. *Neurofibromatosis* - Characterized by **café-au-lait spots**, **neurofibromas**, and **Lisch nodules** (iris hamartomas), not hypopigmented macules. - While seizures can occur, intellectual disability is less common than in tuberous sclerosis, and the distinctive skin lesions differ. *Incontinentia Pigmenti* - Typically presents with **swirling hyperpigmented lesions** (marbled or whorled appearance) that evolve through different stages (vesicular, verrucous, hyperpigmented), not hypopigmented macules. - While it can be associated with seizures and intellectual disability, the skin findings are distinctly different. *Sturge-Weber syndrome* - Characterized by a **port-wine stain** (facial cutaneous angioma) typically involving the ophthalmic division of the trigeminal nerve, ipsilateral leptomeningeal angioma, and ocular abnormalities like glaucoma. - Seizures are common due to brain involvement, but **hypopigmented macules** and subnormal IQ in this configuration are not primary features.

Q: Indication for lumbar puncture in child with febrile seizures are all except?

All infants <6 months. ***All infants <6 months*** - While lumbar puncture should be **strongly considered** in infants under 6 months with febrile seizures, the **American Academy of Pediatrics (AAP)** guidelines do not mandate **routine lumbar puncture for ALL** infants in this age group as an absolute rule. - The current approach emphasizes **clinical assessment**: well-appearing infants without signs of meningitis (e.g., no **lethargy**, **irritability**, or **bulging fontanelle**) may be managed without immediate LP, especially if close observation is possible. - This distinguishes "strongly considered" from "absolute indication," making this the correct answer to the EXCEPT question. *Severely ill infants with clinical signs and symptoms* - **Severely ill infants** with febrile seizures and signs suggestive of meningitis (e.g., **lethargy**, **neck stiffness**, **bulging fontanelle**, **poor perfusion**) are a **strong absolute indication** for lumbar puncture. - The high risk of **bacterial meningitis** in this clinical presentation overrides age or vaccination status, as delayed diagnosis can be life-threatening. *Children 6 to 12 months with no Hib & pneumococcal vaccination* - In children aged 6 to 12 months who are **unvaccinated** or **incompletely vaccinated** against *Haemophilus influenzae type b* (**Hib**) and *Streptococcus pneumoniae*, lumbar puncture is **strongly indicated**. - Lack of immunization against these common causes of **bacterial meningitis** significantly increases risk, making diagnostic LP crucial when febrile seizures occur. *Infants pretreated with antibiotics* - **Antibiotic pretreatment** can mask the clinical signs and symptoms of meningitis, creating a falsely reassuring picture (**partially treated meningitis**). - In such cases, lumbar puncture is **necessary** to confirm or rule out central nervous system infection, as CSF analysis remains the gold standard despite prior antibiotic exposure.

Q: First-line acute management of febrile convulsion in hospital setting includes

IV lorazepam administration. ***IV lorazepam administration*** - **Intravenous lorazepam** is a first-line treatment for acute febrile convulsions, especially in a hospital setting, due to its rapid onset and effectiveness in terminating seizures. - As a **benzodiazepine**, it enhances the effect of GABA, leading to CNS depression and seizure cessation. *Immediate IV phenytoin loading* - **Phenytoin** is typically used for long-term seizure control or in refractory status epilepticus, not as a first-line acute agent for febrile convulsions. - Its slower onset of action makes it less suitable for immediate seizure termination compared to benzodiazepines. *Rectal diazepam* - **Rectal diazepam** is often used for acute seizure management in the **pre-hospital setting** or at home when IV access is not readily available. - In a hospital setting, IV administration of benzodiazepines is preferred due to more precise dosing and faster action. *Oral carbamazepine prophylaxis* - **Carbamazepine** is an anti-epileptic drug used for **long-term prevention** of certain types of seizures, but it is not indicated for acute management of febrile convulsions. - It is not routinely recommended for prophylaxis of recurrent febrile seizures.

Q: A mother brought her child who has got a vascular plaque like lesion over the lateral aspect of forehead mainly involving ophthalmic and maxillary division of trigeminal nerve. Mother says that the lesion has remained unchanged since birth. Also mother gives a history that the child is on valproate for seizure disorder. What is the MOST probable diagnosis?

Sturge weber syndrome. ***Sturge weber syndrome*** - The classic presentation of a **vascular plaque-like lesion** (port-wine stain) in the distribution of the **trigeminal nerve** (ophthalmic and maxillary divisions) from birth, combined with a history of **seizure disorder**, strongly points to Sturge-Weber syndrome. - This neurocutaneous disorder is characterized by a **facial cutaneous angioma**, **leptomeningeal angioma** (leading to seizures), and often **ocular involvement** like glaucoma. *Infantile hemangioma* - While also a vascular lesion, **infantile hemangiomas** typically proliferate in the first few months of life and then involute, rather than being present as a stable "plaque" from birth. - They also don't typically follow a specific trigeminal nerve distribution and are not directly associated with a primary **seizure disorder** as a core feature. *Tuberous sclerosis* - Tuberous sclerosis presents with characteristic clinical features, including **facial angiofibromas** (adenoma sebaceum), **shagreen patches**, and **ash-leaf spots**, which are distinct from a flat vascular plaque. - Although seizures are common in tuberous sclerosis due to **cortical tubers**, the facial skin lesion described does not fit the typical dermatological manifestations of this condition. *Incontinentia pigmenti* - This condition presents with highly characteristic **skin lesions** that evolve through distinct stages, including vesicular, verrucous, and hyperpigmented (swirl-like patterns), which do not match the description of a vascular plaque. - While it can be associated with neurological issues like **seizures**, the dermatological findings are the primary differentiating factor here.

Q: MRI scan of a child with intellectual disability, recurrent seizures and hemangioma. Diagnosis is?

Encephalofacial angiomatosis. ***Encephalofacial angiomatosis*** - This syndrome, also known as **Sturge-Weber syndrome**, is characterized by a "port-wine stain" **facial hemangioma**, leptomeningeal angioma, and ocular involvement. The combination of mental retardation, recurrent seizures, and hemangioma points directly to this diagnosis. - The **leptomeningeal angioma** often calcifies ("tram-track" calcifications) and can be seen on imaging, contributing to the neurological symptoms like seizures and mental retardation. *Epiloias* - Epiloias is another name for **Tuberous Sclerosis Complex**, which presents with facial angiofibromas (not hemangiomas), hypopigmented macules, and neurological symptoms such as seizures and mental retardation. - Imaging typically shows **cortical tubers**, subependymal nodules, and subependymal giant cell astrocytomas, which are distinct from leptomeningeal angiomas. *Neuronal ceroid lipofuscinoses* - This is a group of **neurodegenerative lysosomal storage disorders** characterized by progressive intellectual and motor decline, seizures, and visual failure. - While it causes mental retardation and seizures, it does not involve angiomas or hemangiomas and has different imaging findings (cerebral atrophy, often with thalami and cerebellum spared initially). *Louis Bar syndrome* - Also known as **ataxia-telangiectasia**, this is a rare, neurodegenerative, inherited disease characterized by progressive cerebellar ataxia, **oculocutaneous telangiectasias**, and immunodeficiency. - While it can involve neurological symptoms, the key clinical features are ataxia and telangiectasias, not hemangiomas or the specific imaging findings associated with Sturge-Weber syndrome.

Question 1

All of the following factors are associated with a substantially greater risk of developing epilepsy after febrile seizures, except:

Accepted Answer

Early age of onset

Answer

Complex Febrile seizures

Answer

Developmental abnormalities

Answer

Positive family History of Epilepsy

Question 2

A 4-year old child c/o inability to walk which was first noticed about two months back and worsened gradually. There is no history of fever or injury. There is a history of stress incontinence. On examination child has paraplegia and the anus is patulous. Reflexes are diminished and planters are flexor. There is loss of sensation below umbilicus. The segmental level of lesion is:

Accepted Answer

T 12

Answer

T 6

Answer

T 10

Answer

T 8

Question 3

Moro's reflex persisting for more than 6 months indicates damage to which of the following lobes?

Accepted Answer

Frontal

Answer

Temporal

Answer

Occipital

Answer

Parietal

Question 4

A young child with recurrent bacterial meningitis should be clinically evaluated for the presence of

Accepted Answer

Spina bifida occulta with a dermal sinus tract

Answer

Hypoplastic left heart syndrome

Answer

Syringomyelia of the lower cervical cord

Answer

Holoprosencephaly

Question 5

Which of the following is a FALSE statement regarding Cerebral Palsy?

Accepted Answer

Birth trauma is the most common cause of cerebral palsy

Answer

Cerebral palsy occurs due to one time insult to developing fetal brain

Answer

Periventricular leucomalacia causes spastic diplegia

Answer

Persistent cortical thumb after 3 months of age is seen in spastic cerebral palsy

Question 6

A child presented to the casualty with seizures. On examination multiple oval hypo-pigmented macules were noted on the trunk, along with sub-normal IQ. Probable diagnosis of the child is:

Accepted Answer

Tuberous Sclerosis

Answer

Neurofibromatosis

Answer

Incontinentia Pigmenti

Answer

Sturge-Weber syndrome

Question 7

Indication for lumbar puncture in child with febrile seizures are all except?

Accepted Answer

All infants <6 months

Answer

Severely ill infants with clinical signs and symptoms

Answer

Children 6 to 12 months with no Hib & pneumococcal vaccination

Answer

Infants pretreated with antibiotics

Question 8

First-line acute management of febrile convulsion in hospital setting includes

Accepted Answer

IV lorazepam administration

Answer

Immediate IV phenytoin loading

Answer

Rectal diazepam

Answer

Oral carbamazepine prophylaxis

Question 9

A mother brought her child who has got a vascular plaque like lesion over the lateral aspect of forehead mainly involving ophthalmic and maxillary division of trigeminal nerve. Mother says that the lesion has remained unchanged since birth. Also mother gives a history that the child is on valproate for seizure disorder. What is the MOST probable diagnosis?

Accepted Answer

Sturge weber syndrome

Answer

Infantile hemangioma

Answer

Tuberous sclerosis

Answer

Incontinentia pigmenti

Question 10

MRI scan of a child with intellectual disability, recurrent seizures and hemangioma. Diagnosis is?

Accepted Answer

Encephalofacial angiomatosis

Answer

Epiloias

Answer

Neuronal ceroid lipofuscinoses

Answer

Louis Bar syndrome

Neurology — MCQs

Neurology — MCQs

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