MRCP Part 2 Category: Neurology

MRCP2-3195

An 77-year-old man was brought to the emergency department by his wife due to concerns about his speech and left-sided weakness. These symptoms had been present since breakfast that morning and had persisted throughout the day. The patient has a history of hypertension and takes amlodipine, but is otherwise independent in his daily activities and does not smoke.

Upon examination, the patient was found to have dysarthria and hemisensory loss on his left side, with 2/5 power in his left leg and arm. His pulse was irregular, but his vital signs were stable. A CT angiogram with perfusion imaging revealed a thrombus in the right middle cerebral artery, with a small area of infarct and a large area of surrounding ischaemic penumbra.

What is the most appropriate course of action for managing this patient?

MRCP2-3180

A 32-year-old man presents with complaints of difficulty concentrating and irregular jerky movements in his extremities and fingers. He reports consuming around 20 units of alcohol per week and has a family history of dementia, with his father being diagnosed at the age of 40. On examination, he displays generalised choreiform movements, but his neurological and systemic examination is otherwise unremarkable. What is the probable diagnosis?

MRCP2-3181

A 50-year-old man presents to the emergency department with a sudden onset headache that began 2 hours ago while he was at work. He denies vomiting but reports feeling nauseated. His medical history includes hypertension and he takes ramipril, amlodipine, and indapamide.

Upon examination, his GCS is 15/15. His heart rate is 80 beats/min and his blood pressure is 150/92 mmHg. There are no signs of head trauma. His pupils are equal and reactive to light, but he complains of photophobia.

What is the immediate management for this patient?

MRCP2-3182

A 27-year-old female patient presents to the Emergency Department complaining of a severe headache that has been progressively worsening over the past two to three months. She also reports experiencing blurred vision. The patient has a history of depression, which she attributes to her weight problem and bad skin. However, she has been actively trying to address these issues by joining Weight Watchers and receiving treatment for her acne from her GP for the past four months. On examination, the patient is overweight and has moderately severe acne. She is afebrile, and there are no signs of nuchal rigidity. The oropharynx is benign, and the neurological examination is normal, except for blurred disc margins bilaterally and a limited ability to abduct the left eye. What is the most likely diagnosis?

MRCP2-3183

A 26-year-old female patient is admitted with a history of headaches for the past eight weeks. The headaches have worsened significantly over the last two days and are now constant and unbearable. The patient has found some relief from paracetamol, but the headaches have been problematic in the morning. The patient has gained 6 kg in weight over the last six months. On examination, the patient is noted to be obese with a BMI of 32 kg/m2 and a blood pressure of 122/76 mmHg. Fundoscopy reveals bilateral swelling of both optic discs with loss of venous pulsation, but otherwise, neurological examination is normal. Investigations reveal normal MRI appearances of the brain, and a lumbar puncture reveals an opening pressure of 30 cm H2O, but CSF analysis is normal. What is the most likely diagnosis?

MRCP2-3184

You assess a 27-year-old female patient who complains of frequent headaches and transient vision disturbances. She also experiences dizziness and double vision on several occasions. Her BMI is 32 and bilateral papilloedema is observed during the examination. A CT scan shows no mass lesion, but a lumbar puncture reveals an elevated opening pressure. You suspect the patient has idiopathic intracranial hypertension (IIH).
What risk factor is associated with a higher prevalence of idiopathic intracranial hypertension?

MRCP2-3185

A 26-year-old female patient has been experiencing headaches for six weeks, which worsen in the morning and when lying down. She also reports diplopia and brief episodes of visual loss (lasting seconds) upon standing up. On clinical examination, the patient is found to be obese with a blood pressure of 120/70 mmHg. Fundoscopy reveals bilateral blurring of optic discs and horizontal diplopia when looking towards the right. A CT scan of the brain without contrast shows no abnormalities. What is the most appropriate next investigation for this patient?

MRCP2-3186

A 44-year-old white Caucasian female presents to the Emergency Department with complaints of being unable to walk and problems with vision in her right eye. She has no significant medical history and has only visited her GP once before for a bout of diarrhoea and vomiting.

On examination, a right relative afferent pupillary defect is noted, and there is a patchy loss of sensation on the right lateral wrist and anterior aspect of the left lateral shin. An urgent MRI head and whole spine reveals abnormal high signal in the cervical cord from C3 to C7. A lumbar puncture was performed, and the results show a WCC of 12 mm/³, RBC <1 mm/³, protein of 0.9 g/l, glucose of 5.2 mmol/l (10.2 mmol/l serum), and oligoclonal bands and viral PCR results are pending. What is the most likely diagnosis?

MRCP2-3187

A 65-year-old woman presented with symptoms of dizziness, nausea, and vomiting that had developed gradually over the past day. She reported a constant sensation of the room spinning, which worsened with sudden movements. The patient had experienced flu-like symptoms the previous week, which were now resolving. During the examination, the patient exhibited horizontal nystagmus with the fast beat towards the right. Speech was normal, and finger-nose testing and gait were normal. There was no past-pointing, and the patient had 5/5 power throughout all limbs. Hearing was normal. What is the most likely diagnosis?

MRCP2-3188

A 35-year-old man who is 25 weeks pregnant with his first child comes to the Emergency Department. He has been experiencing increasingly severe morning headaches over the past four weeks and, over the past three days, has developed double vision and feels that his vision is fading when he leans forward. Upon examination, his blood pressure is 120/80 mmHg and his pulse is 80 bpm and regular. He is obese with a body mass index of 34 kg/m2. There is bilateral papilloedema, but his eye movements are unaffected.
Investigations;
Investigations Results Normal Values
Haemoglobin (Hb) 120 g/l 115–155 g/l
White cell count (WCC) 6.5×109/l 4–11 × 109/l
Platelets (PLT) 180×109/l 150–400 × 109/l
Sodium (Na+) 138 mmol/l 135–145 mmol/l
Potassium (K+) 4.0 mmol/l 3.5–5.0 mmol/l
Creatinine 92 µmol/l 50–120 µmol/l
Computed tomography (CT) head and CT venogram with abdominal shield, Normal intracranial appearances, no venous sinus thrombosis identified
What is the most appropriate next step?