THE NEUROLOGY

Introduction Inflammatory myopathies are a group of rare diseases that cause muscle inflammation and weakness. They are autoimmune diseases. Common types include polymyositis, dermatomyositis and Inclusion body myositis. What are the features of Inflammatory Myopathies? Polymyositis is a rare disease Ocular and facial muscle weakness present in polymyositis Dermatomyositis occurs in children and adults Inclusion body myositis (IBM) present in 30-to-40 year of age Serum creatine phosphokinase (CPK) level may be normal Bohan & Peter Diagnostic Criteria For Dermatomyositis / Polymyositis Symmetric proximal muscle weakness Elevated muscle enzyme creatine phosphokinase (CPK) levels A myopathic pattern on electromyogram (EMG) Evidence of an endomysial, mononuclear inflammatory infiltrate on muscle biopsy Characteristic skin rash of dermatomyositis (Heliotrope rash or Gottron’s papules) For Definite Polymyositis: All first four criteria must be present For Definite Dermatomyositis: Charac...

✍️ Neurology: Self-Assessment || Stroke || Part 02 || Dear Neurology Aspirants! Please! Watch the video for Self-Assessment. The assessment video contains 30 questions from the Chapter: Stroke. The video used objective questions from “The Neurology: Self-Assessment & Review" by Dr. Sunil Kumar. Hope! This will help you to manage your time in the examination hall. Best of Luck!

✍️ Introduction: When you try to kiss someone, do you know which brain part decides the speed, distance and force of lip movement during a kiss? The best kiss is nothing but a fine coordinated movement of orbicularis oris muscle. Now you are thinking, who controls the coordinated movement of the lip? It is cerebellum! ✍️ Question: Who said - “rate, range, and force of movement is governed by the cerebellum. Sir Joseph Babinski Gillman & Gillman Gordon Holmes Sir Charcot ✍️ Explanation: The cerebellum monitors the rate, range, and force of the movement. The cerebellar diseases do not cause motor weakness but it produces unilateral in-coordination. According to Gordon Holmes, cerebellum controls the “rate, range, and force” of movement. ✍️ Answer(s): 3. Gordon Holmes ✍️ Reference: Holmes, Gordon. “The Croonian Lectures on the Clinical Symptoms of Cerebellar Disease and Their Interpretation. Lecture II. 1922.” Cerebellum (London, England), vol. 6, no. 2, 2007, pp. 148–53; discussion...

Multiple Choice Questions in Neurology: What is the value of normal resting nerve action potential? -30 mv -40 mv -50 mv -70 mv Resting Nerve Membrane Potentials At the resting state of the neurons: More sodium ions are outside More potassium ions are inside The inside of the neuron is negative relative to the outside In the resting state, the outside of the nerve cell (extracellular) has zero potential so the resting membrane potential is equal to the voltage inside the cell (intracellular). The normal resting membrane potential of a neuron is -70 mV. Remember, the negative (-) means the inside of the neuron is 70 mV less than the outside. The resting nerve membrane potential is because of potassium (K) ions. Reference(s): Hodgkin, A. L., and A. F. Huxley. “Resting and Action Potentials in Single Nerve Fibres.” The Journal of Physiology, vol. 104, no. 2, 1945, pp. 176–95, doi:https://doi.org/10.1113/jphysiol.1945.sp004114. [Answer is 4. -70 mv] Multiple Choice Questions in Neurol...

Multiple Choice Questions in Neurology: Characteristic feature(s) of Gerstmann's syndrome: Alexia Acalculia Anomia Right and left confusion Finger anomia Dyscalculia Alexia Difficulty in reading or understanding the written words Acalculia / Dyscalculia Acquired disorder of calculation abilities Inability to perform known arithmetic functions Anomia Difficulty in word finding Impairment of retrieving known words Intact comprehension Intact word repetition Agnosia Inability to retrieve known sensory information Auditory agnosia: inability to recognize or differentiate between sounds Visual agnosia: inability to recognize objects Finger agnosia: inability to name, distinguish or recognize the own or others fingers Prosopagnosia Facial agnosia Inability to recognize known or familiar faces Simultanagnosia Disorder of visual attention Ability to visualize a single object of a whole scene Unable to visualize more than a single object at a time Unable to visualize the overall meaning of ...

Multiple Choice Questions in Neurology: Anterior communicating artery (ACom) originates from which part of the anterior cerebral artery (ACA)? A3 - segment A1 - segment A2 - segment A4 - segment Anterior Cerebral Artery   Anterior Communicating Artery (ACom) It is about 4 mm in length. The anterior communicating artery is an anastomosis between the left & right anterior cerebral artery circulation. It originates from the anterior cerebral artery - A1 segment. Applied Anatomy Anterior communicating artery (ACom) is the most common site for intracranial aneurysm. Anterior communicating artery (ACom) aneurysm may cause bitemporal heteronymous hemianopia. Anterior Cerebral Artery Anterior cerebral artery arises from the internal carotid artery. It is divided into five segments. A1: Pre-communicating segment Medial lenticulostriate arteries Anterior communicating artery A2: Post-communicating segment Recurrent artery of Heubner Orbitofrontal artery Frontopolar artery A3: Pre-callosa...

Multiple Choice Questions in Neurology: What are the triads of Tuberous sclerosis? Seizure Focal cortical atrophy Mental retardation Adenoma sebaceum Port wine nevus Tuberous Sclerosis Tuberous sclerosis is also known as Bourneville disease Inheritance Autosomal dominant inheritance Tuberous sclerosis 1 (TSC1): HAMARTIN (chromosome 9q32-34) Tuberous sclerosis 2 (TSC2): TUBERIN (chromosome 16p13.3): Most common Clinical Features Childhood onset Multiple Ectodermal Benign Tumours Skin: sebaceous glands Eyes: retina Nervous system: brain, spinal cord Mental retardation, learning difficulty, attention deficit hyperactivity disorder (ADHD) are common. Multiple hamartomas Brain histopathology shows disorganized cortical lamination with indistinct gray and white matter junction. Cardiac rhabdomyomas are multiple hamartomas that usually regress over time. Cardiac rhabdomyoma (benign tumors) may present in 50% of patients. The incidence in the newborn may be as high as 90% and in adults as low ...

Multiple Choice Questions in Neurology: True and False statements about Kennedy Syndrome: CAG repeat Gynecomastia Testicular atrophy Peripheral neuropathy Ocular muscle involvement Kennedy's Disease Inheritance X-linked recessive disorder Trinucleotide repeat: CAG gene Clinical Features Slowly progressive limb-girdle type muscle weakness Slowly progressive bulbar dysfunction Early tremor Muscle cramps Fasciculations Marked abnormal sensory nerve conduction study Degeneration of both motor and sensory neurons Lower motor neurons signs Elevated serum creatine kinase Abnormal sex hormone levels Gynecomastia Testicular atrophy Diabetes mellitus Note: Extraocular muscles are spared. References: Fischbeck, K. H. "Kennedy disease." Journal of inherited metabolic disease 20.2 (1997): 152-158. Sperfeld, Anne D., et al. "X-linked bulbospinal neuronopathy: Kennedy disease." Archives of Neurology 59.12 (2002): 1921-1926. [Answers are A. CAG repeat-True, B. Gynecomastia-True...

Multiple Choice Questions in Neurology: Somatic cells form by two copies of alleles during the fertilization, one copy inherited from each parent. However, if gene expression occurs from only one allele i.e. one parent, is called genomic imprinting. Which of the following is/are associated with genomic imprinting disorders? Fragile X Syndrome Angelman Syndrome Myotonic Dystrophy Prader Willi Syndrome Huntington's Disorder Genomic Imprinting Disorders Normally, somatic cells form by two copies of alleles during the fertilization, one copy inherited from each parent. However, if gene expression occurs from only one allele i.e. one parent, is called genomic imprinting. Epigenetic phenomena do not involve alterations in the DNA sequence. It usually affects functional activity and expression of genes. Genomic imprinting is an epigenetic phenomena. Imprinted alleles/genes of the parent are silent. Only non-imprinted alleles/genes of parents are expressed in children. Imprinted alleles/ge...

Multiple Choice Questions in Neurology: A 50-year-old obese female patient presented in OPD with complaints of burning & tingling sensation in her feet for six months. She had off & on lower backache since six months. She had  medical history of dyslipidemia, hypertension and diabetes mellitus for the last five years. She was on Atorvastatin, Metoprolol, Losartan and Metformin. Examination of the patient revealed hyperesthesia and decreased vibration sense in the feet. Bilateral ankle jerks were absent. What could be the most probable diagnosis of this female? Diabetic Polyneuropathy Lumbosacral Radiculopathy Atorvastatin Induced Muscle Cramps Metformin can cause lactic acidosis and leads to muscle pain and cramps Discussion: Burning & tingling sensations are paresthesias. Predominantly distal paresthesias are suggestive of peripheral neuropathy. She was suffering from Diabetes mellitus, which also favors the diagnosis of peripheral neuropathy. Though, sh...

High Yield Facts ⭆ 1. About fifty percent of the pediatric migraine patients continue to have migraine headache in adulthood. 2. Like adult migraine, Topiramate and Amitriptyline can be used as pharmacological prophylactic therapy in Pediatric Migraine. 3. Childhood onset migraine is a primary headache disorder. 4. Worldwide prevalence of Pediatric Migraine headache is around 7% to 8%. 5. About 30% of migraine patients, first start headache in childhood. 6. Before puberty, incidence of migraine headache is equal in male and female. Pediatric Migraine Headache Question True about Pediatric Migraine Headache, except: Pediatric migraine has no risk of developing adulthood migraine. Like adult migraine, Topiramate and Amitriptyline can be used as pharmacological prophylactic therapy in pediatric migraine Pediatric migraine headache is a primary headache Worldwide prevalence of pediatric migraine headache is around 7% to 8% References: Al-Twaijri, Waleed A., and Mic...

High Yield Facts ⭆ Acetylcholine released in postsynaptic cleft and binds to α-subunit of acetylcholine receptor. When acetylcholine bind a nicotinic AchR, a conformational change occurs in the receptor, resulting in the formation of an ion pore. The opening of a ion pore produces a rapid increase in the cellular permeability of sodium and calcium ions, resulting in the depolarisation and excitation of the muscle cell. It activate the sodium channel and depolarizes the nerve fibers. Direction of transmission of nerve impulse from postsynaptic junction to nerve fibers. Question Which of the following ion channel opens, when acetylcholine (ACh) binds to acetylcholine receptor (AChR) at postsynaptic junction? Potassium (K) Chloride (Cl) Calcium (Ca) Sodium (Na) Acetylcholine Receptors Two types of Acetylcholine Receptor: Muscarinic Type: G-Protein Coupled Receptor. Slow metabolic response through intracellular secondary messenger system involving an increase of intracellula...

High Yield Facts ⭆ Synaptic transmission at the neuromuscular junction begins when an action potential reaches the presynaptic terminal of a motor neuron, which activates voltage dependent calcium channels to allow calcium ions to enter the neuron. Calcium ions bind to synaptic vesicles, triggering vesicle fusion with the cell membrane and subsequent neurotransmitter release from the motor neuron into the synaptic cleft. Motor neurons release acetylcholine (ACh) neurotransmitter, which diffuses across the synaptic cleft and binds to nicotinic acetylcholine ionotropic receptors (nAChRs) on the cell membrane of the muscle fiber. The binding of ACh to the receptor can depolarize the muscle fiber, results in muscle contraction. Normally, Acetylcholine (ACh) binds to α-subunit of Acetylcholine Receptor (AChR) at postsynaptic junction. Which ion is responsible for transmission of impulse from postsynaptic junction to nerve fibers? Chloride (Cl) Calcium (Ca) Sodium (Na) Magnesium (Mg)...

How many spinal arteries supply the human spinal cord? Three Arteries Four Arteries Five Arteries Two Arteries Blood Supply of Spinal Cord Arterial Supply The spinal cord is supplied by Three Longitudinal Arteries : One Anterior Spinal Artery supplies the anterior two-thirds of the spinal cord. Two Posterior Spinal Arteries supply the posterior one-third of the spinal cord. [Mnemonics: Posterior is Paired, Posterior = Paired] Venous Drainage There is a complex network of intrinsic, extrinsic, and extradural systems. The anterior and posterior spinal veins and anterior and posterior radicular veins are freely communicate with the internal vertebral plexus in the epidural space. This drains into the cerebral dural venous sinuses and cerebral veins as well as the external vertebral plexus. The veins of the spinal cord and vertebral column are valveless. Reference: Bosmia AN, Hogan E, Loukas M, Tubbs RS, Cohen‐Gadol AA. Blood supply to the human spinal cord: part ...

Question: Which of the following is a Histone Deacetylase Inhibitor? Phenytoin Sodium Valproate Carbamazepine Levetiracetam  Histone Deacetylase Inhibitor Histone deacetylase-9 (HDAC9) gene is associated with pathogenesis of large artery ischemic stroke. HDAC9 inhibitor may prevent ischemic stroke. Sodium Valproate is a nonspecific Histone Deacetylase Inhibitor. Sodium Valproate therapy given after ischemic stroke may be associated with reduced recurrent stroke rate. Reference: Brookes RL, Crichton S, Wolfe CD, Yi Q, Li L, Hankey GJ, Rothwell PM, Markus HS. Sodium Valproate, a Histone Deacetylase Inhibitor, Is Associated With Reduced Stroke Risk After Previous Ischemic Stroke or Transient Ischemic Attack. Stroke. 2018 Jan;49(1):54-61. [Answer is 2. Sodium Valproate]

#The Neurology Question: True & False: Restless Legs Syndrome Symptoms start with sleep Dystonia and myoclonus Symptoms aggravate with dopaminergic agonist Normal Brain MRI Sensory symptoms on awakening (Source: The Neurology: Self-Assessment & Review By Dr. Sunil Kumar , www.theneurology.org ) Reference: Picchietti DL, Stevens HE. Early manifestations of restless legs syndrome in childhood and adolescence. Sleep Med. 2008;9(7):770-781. Restless legs syndrome affects approximately 10% of the adult population. Clinical Features The four core symptoms required for diagnosis are as follows: An urge to move the legs: usually caused or accompanied by an unpleasant sensation in the legs Symptoms begin or worsen with rest Partial or complete relief by movement Worsening during the evening or night Symptoms most commonly begin in the legs, but can spread to or even begin in the upper limbs. The unpleasant sensation is often...

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Introduction: Syncope is a sudden, transient loss of consciousness. It recovers rapidly without any neurological sequel. It is because of transient hypo-perfusion of the brain. It should be differentiated from convulsive seizure. Differentiating Features Between Syncope & Convulsive Seizure Syncope Precipitating Factors Prolonged standing Voiding of urine Prolonged coughing Prolonged fasting Alcohol intoxication Strong emotional reaction Premonitory Symptoms Dizziness Lightheadedness Excessive perspiration Epigastric discomfort Blurring of vision or blackout Facial pallor Paresthesia Others Posture of the patient: Mostly occur in standing posture Progression of unconsciousness: Mostly immediate Duration of episode: Loss of consciousness occur for few seconds Tongue bite: Rarely Involuntary jerking movements of limbs: Rarely Ictal urinary incontinence: Rarely Post-ictal headache: Rarely Convulsive Seizure Precipitating factors: Usually none Premonitory Symptoms: Aura or Déjà vu Po...

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The Neurology: Self-Assessment & Review