Discuss the following
1 – Inflammatory epilepsies
Give short account on:
1- Oral therapy in MS
2- Obstructive sleep apnea and risk of stroke
3-Recent concepts in treatment of alzehiemer dementia
4- Parkinson,s disease subtypes
5-Silent bain infarcts
MD degree in Neurology
Commentary
Date: 7-5-2013
Time allowed: 1.5 hrs
A 60-year-old woman presents with abnormal behavior, irritability, disorientation, forgetfulness, unsteadiness while walking, and repeated falls. Her symptoms have evolved gradually over the past 3 months; she is now unable to recognize her immediate family or feed herself, and she has become incontinent. She has also developed intermittent jerking movements in her limbs, not had any witnessed tonic-clonic seizures or headaches. She has no history of hypertension or diabetes. Her family history is significant only for cardiovascular disease. She has not undergone any recent surgeries or received any transfusions of blood products in the past.
The CT scan demonstrates nonspecific cerebral atrophy and several areas of calcification within the basal ganglia.
She has no thyromegaly, lymphadenopathy, Pallor, or jaundice. The cardiac, respiratory, abdominal examinations are normal. There are no signs of meningeal irritation. The patient responds to calls, but her attention cannot be sustained. She is disoriented to time and place and is unable to identify her husband or her children. Her memory for recent and past events is impaired. She comprehends simple commands, but her speech is slurred.
The patient's CBC, glucose, urea, creatinine, electrolytes, and liver function examinations are all normal, as are her serum ammonia, ceruloplasmin, copper, thyroid, and parathyroid hormone findings. Serum levels of antithyroperoxidase antibodies are also normal. The patient's ECG, echocardiogram, chest radiographs, and ultrasound of the abdomen are all normal. CT scans of the chest and abdomen do not reveal any evidence of neoplasms or other illness.
The patient's cranial nerve examination is normal. She has intermittent myoclonic jerks involving all of her limbs. She moves all limbs briskly but is unable to sit or stand without assistance, and she cannot walk, even with assistance. The patient's reflexes are brisk but symmetric. She responds to pain, but the remainder of her sensory examination cannot be reliably assessed.
CSF analysis in this patient reveals acellular fluid, with normal glucose and protein levels. The bacterial cultures and smears for acid-fast bacilli and Cryptococcus and the cytology results are negative. Cryptococcal antigen and measles antibodies are not detected in the CSF. The polymerase chain reaction examinations for Mycobacterium tuberculosis and herpes simplex virus are negative.
The patient's enzyme-linked immunosorbent assay for HIV and the Venereal Disease Research Laboratory test for syphilis are both negative. Serum B12, folate levels, and arterial lactate levels are in the normal range. Testing for antinuclear antibodies, antineutrophil cytoplasmic autoantibodies and antibodies to double-stranded DNA, as well as for antibodies to thyroid peroxidase and thyroglobulin, are all negative. The toxicology screens for lead, mercury, and arsenic are all negative.
The patient's MRI reveals hyperintense signals within the cortical ribbon , basal ganglia, and thalamus. The "double hockey stick sign" refers to increased signal in the medial thalamus and pulvinar.
The EEG demonstrates 1-second periodic sharp wave complexes superimposed on a slow background.
what diagnosis is likely?
what D D is likely?
What additional histologic findings may be found?
what lines of treatment are likely?