A 60-year-old woman complains of unpleasant sensations in the legs accompanied by an urge to move the legs. The sensations occur only at night when she is inactive and sometimes occur in bed making it difficult to get off to sleep. There are no abnormal signs on examination of the legs and she is otherwise in good health.
Select from the list the single most likely diagnosis.
A 78-year-old man comes to the clinic with a change in his behaviour, his wife has also noticed a few aggressive outbursts over the past months. His mini-mental test score is 20.
Which patterns of cognitive deficit would favour a dementia of subcortical origin?
A 60-year-old man presents with a 2-month to 3-month history of slurred speech as well as difficulty in chewing and swallowing, to the point where he is no longer eating solid food. On examination he has weakness of jaw closure and difficulty in protruding his tongue. There is some wasting and fasciculation involving both sides of the tongue. He has lost a few kilos in weight over this time. Apart from a generally thin appearance, the rest of the neurological and general examination appears to be normal. In particular, the tendon reflexes are all within physiological limits.
Select the most likely diagnosis.
What is the correct statement regarding migraine from the list provided?
A 29-year-old woman began to stumble when walking. Her right leg was slightly stiff and weak, especially after exercise and hot showers. These symptoms developed over 3 days and gradually disappeared over 4 weeks. She was on the college swimming team before these symptoms arose. There, she developed a unique and extreme type of fatigue that was different from the usual fatigue she experienced when swimming. This disappeared after several weeks, but reappeared again 6 months before her current presentation.
Select the single most likely diagnosis.
A 25-year-old man presents to you with concerns that he may be losing his mind. He reports experiencing peculiar odors (such as burnt rubber) and frequently feeling jamais vu. No one else detects any unusual smells during these episodes. He remains fully conscious and has excellent recall of the events. What is the probable diagnosis?
A 30-year-old man visits his General Practitioner with concerns about the increasing frequency of his migraines. He used to experience headaches once or twice a month, but over the past four months, he has had to take sumatriptan around 20 days a month. He occasionally combines it with co-codamol, but this doesn’t alleviate the pain.
What is the best guidance you can offer this patient?
A 30-year-old man presents to the General Practitioner with sudden onset weakness of the muscles on the left side of his face. He is unable to wrinkle his forehead and has difficulty closing his eye. Additionally, he reports loss of taste on the anterior part of his tongue and discomfort with loud noises. What is the most probable diagnosis?
A 40-year-old accountant has come to seek your advice regarding driving restrictions. He recently experienced a seizure and was referred to a neurologist for further investigation. Despite showing symptoms of a seizure, all tests, including EEG and imaging, came back normal. The neurologist concluded that it was a solitary fit and advised against medication. The patient has been discharged from further follow-up but was instructed to inform the DVLA. He has come to you for guidance on how long he should refrain from driving his car after the initial seizure.
Can you provide information on the potential causes of seizures in adults?
A 42-year-old woman presents with a no-no head tremor and an action tremor of the hands. There are no other neurological abnormalities.
Select the most appropriate initial treatment.