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Question 1
Does a lesion of Guillain–Mollaret’s triangle in the brain stem cause a
type of myoclonus other than symptomatic palatal myoclonus?
Question 124
1. In West’s syndrome, after the fits have been suppressed, for how
long should treatment with adrenocorticotrophic hormone (ACTH)
continue?
2. Does complete suppression of resistant infantile myoclonic jerks by
ACTH characterize West’s syndrome?
Question 125
Are anticholinergics the first line of treatment for primary torsion
dystonia?
Question 126
Can multiple sclerosis (MS) be associated with lack of vitamin D,
lack of sunlight or low fish/cod-liver oil in the diet? By looking at the
epidemiology (none at the equator; more outside 40° latitude, both north
and south; less on top of Swiss mountains than in the Swiss valleys; more
in fishing coastal towns and in Eskimos) this seems to be very important.
Vitamin D modulates the immune system and active vitamin D given
to rats with experimental MS (acute encephalomyelitis) lowers the
monocyte count in cerebrospinal fluid (CSF) by 90% in 72 hours with
return of power to their limbs. Japanese MS patients who ate plenty of
fish were found to have vitamin-D-receptor pleomorphism. The staple
grains and cereals (wheat, barley, oats) eaten in Scandinavian and
northern European countries contain phytic acid, which blocks vitamin D
absorption, and rice is the only cereal free of phytic acid.
Are there any studies where low vitamin D levels in blood are
associated with MS relapse?
Buy The Management Of Meningococcaemia
Question 127
What are the diagnostic criteria of ‘definitive’ multiple sclerosis (MS) – as
taught to a medical student? We have found different information from
different sources.
Question 128
How reliable is a CT-brain scan with contrast in showing MS lesions as
enhancing lesions in the presence of a contraindication to use MRI?
Question 129
Is magnetic resonance (MR) spectroscopy of value in differentiating
multiple sclerosis from cerebral autosomal dominant arteriopathy with
subcortical infarctions (CADASIL)?
Neurological disease 21
235
Question 130
Does hemiplegia due to multiple sclerosis present with hemiparesis
rather than dense hemiplegia (which is more characteristic of a stroke)?
Other than age, what are the clinical signs that would help differentiate
between the two?
Question 131
If a female patient with multiple sclerosis wants to become pregnant,
what are the risks, family planning advice and treatment, etc? What is the
best advice to give to her?
Question 132
Is there a role for methotrexate and azathioprine in the treatment of
remitting-relapsing multiple sclerosis?
Question 133
Do steroids have a role in preventing or ameliorating the relapses in
relapsing-remitting multiple sclerosis?
Question 134
Has cyclophosphamide a role in decreasing the rate and number of
relapses in relapsing-remitting multiple sclerosis?
Question 135
Is there evidence of the efficacy of cyclic pulse cyclophosphamide
therapy in the treatment of relapsing-remitting multiple sclerosis?
Question 136
Glatiramer acetate and interferon-beta are recommended by some people
for the treatment of multiple sclerosis. Which drug should I use for a
patient with a 2-year history of relapsing-remitting MS.
Question 137
1. Most neurological books available to me say that high-dose IV
dexamethasone can be used in acute relapses of multiple sclerosis
(MS). What is the recommended dosage and regimen for this drug?
2. I understand that depot preparations of betamethasone (Depofos)
can also be used in acute relapses of MS, as well as treatment for
idiopathic Bell’s palsy. If so, can you tell me the recommended dosage
and regimen for this drug?
Question 138
What are the most common causes of chronic meningitis and what
investigations must be done?
21 Neurological disease
236
Question 139
What is Hib meningitis?
Question 140
How often is tuberculosis a cause of chronic meningitis in comparison to
other causes?
Question 141
Is cavernous sinus thrombosis a complication of meningitis?
Question 142
What is the mechanism of paraparesis that comes as a late (i.e. postresolution) complication to meningitis?
Question 143
Is lumbar puncture contraindicated in meningococcal meningitis?
Question 144
What should the cerebrospinal fluid (CSF) picture be when the treatment
of acute bacterial meningitis is complete, and after how many days of
treatment?
Question 145
In the management of meningococcaemia, can chloramphenicol be
used as an alternative? Are there any advantages practically? The book
quotes benzylpenicillin or cefotaxime (alternative). Are they a standard
regimen?
Question 146
‘The immediate management of suspected meningococcal meningitis
infection is benzylpenicillin 1200 mg either by slow IV injection or
intramuscularly, prior to investigations.’
Is this always true? Should you not perform a lumbar puncture for
culture first?
Question 147
Should children with bacterial meningitis be treated with steroids to
prevent complications?
Question 148
What is the role of anticonvulsants in a case of encephalitis and how long
should one continue them?
Question 149
How effective are steroids in the treatment of radiculomyelitis?
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