1.Impaired Upgaze is a normal phenomenon while downward gaze impairment with Parkinsonism indicates Progressive supra nuclear palsy(PSP)
2.DVLA Advocates for 6 months off from driving if patient had solitart unprovoked seizure.
This period extends to 3 years in case of multiple unprovoked seizure while asleep.
3.an adolescent patient presents with cerebellar signs such as gait disturbances, dysarthria ,nystagmus and her history reveals that her parent is epileptic --- MCC Of symptoms are phenytoin toxicity , patient has easy access to her parents epileptic medication and she is abusing it.
4.in comparatively younger patient who has early Parkinson's disease , always use Dopamine agonist such as Pramipexole over Levo Dopa.
5. Classical scenerio of a badminton or squash player who has suddenly fallen during game and complaints of aching pain in back of his head and neck( in some cases patient present with horner's and other neurological symptoms and in some with simply neck pain)------Carotid artery dissection.
6.even though if the level of total cholesterol is subnormal in TIA patient
Always put him on 40 mg simvastatin for secondary prevention of vascular events.
7.Painful third nerve palsies are a feature of aneurysms of posterior communicating artery. Other possible conditions which can cause are caroto-cavernous fistula and ischemic diabetic lesion ,however pain is less prominent feature in these two conditions .
8.Anterior inferior cerebellar artery occlusion causes Lateral inferior pontine infarction which present as vertigo ,vomiting, horizontal and vertical nystagmus ,and ipsilateral nystagmus.ipsilaterallu LMN facial weakness ,paresis of conjugate lateral gaze ,cerebellar ataxia , horners and sometime deafness.
9.RIGHT INFERIOR DIVISION OF MIDDLE CEREBRAL ARTERY occlusion lead to apractagnosia , anosgnosia ,unilateral neglect ,agnosia for the left half of external space , dressing apraxia and constructional apraxia.
10. An adolescent female presents with spells of ' staring and stuperness', fluttering of eyelids .episodes last for few minutes. Also complains of sudden shock like contractions of limbs.EEG reveals 4-6 hz irregular polyspike activity :- Juvenile Myoclonic Epilepsy. Treat with Valproic acid Indefinitely.
11.Stiff Person syndrome:-
Persistent spasm particularly of the proximal lower limbs and lumbar paraspinals lead to exaggerated lumbar lordosis.it has middle age ,insidious onset.muscle spasm usualy dosaapear while sleep and there is normal EMG.Absence of trismus differentiate it from Tetanus.
