This document contains 15 case studies presenting with various neurological symptoms. The case studies are seeking to test knowledge of diseases such as multiple sclerosis, meningitis, Guillain-Barré syndrome, and more. Diagnostic methods and treatments are discussed. Key information includes symptoms, diagnostic testing results, medical histories, and questions regarding diagnosis and management.

1. Nurology case studys on demylinating diseases
1. A 65-year-old gardener was brought by his wife to the outpatient
clinic. She was concernedabout his poor memory.He was able to give
some details regarding his early life, although these were
chronologically inaccurate,but he could remember nothing at all
about the preceding 4 months. He was able to retain new information
for a few minutes but then forgot it. His knowledge ofcurrent events
was very poor.this have been diagnosed as encephalomyelitis ofbrain
by laboratory evidence.
1)what is the cause of this disease?
2)which types ofdiagnostic methods do you know for this?
3)treatment?
2. a patient 25 years neurological signs from the inflammatory attackoften
begin with fever, headache, and vomiting. Encephalopathy (damage or
malfunctionof the brain) . This results in symptoms,suchas altered level of
consciousness,acute cognitive dysfunction, behavioral changes,and seizures
in about a third of those diagnosed. The alteredconsciousness canrange
from lethargy to coma.
1)which disease causing this symptoms?
2)what is first line treatment for this patient?
3. Which of the following medication act by modulating sphingosine-1-
phosphate receptor (S1P1):
a. Teriflunomide
b. Fingolimod
c. Interferon-β
d. Glatiramer acetate

2. 4. The assay that demonstrated the highest sensitivity in detecting
aquaporin-4 antibodies in cases of neuromyelitis optica is:
a. Cell-based assay
b. Enzyme-linked immunosorbent assay
c. Indirect immunofluorescence assay
d.Immunoprecipitatio
5. Regarding Acute disseminated encephalomyelitis (ADEM) all true
except:
a. Also known as postvaccinal encephalomyelitis whenit follows vaccination
b. Always amonophasic illness
c. Lesions on MRI may be present in the optic nerves and spinal cord
d. More commonin childrenthan adults

3. 6. Ms rupa is a 35 year oldwhite female. She came to Neurology Clinic for
evaluationof her long-term neurologic complaints.The patient relates that
for many years she had noticedsome significant changes in neurologic
functions, particularly heat intolerance precipitating a stumbling gait and a
tendency to fall. Her visual acuity also seemedto change periodically during
several years.Two months ago the patient was working very hard and was
under a lot ofstress.She got sickwith a flu and her neurologic condition
worsened.At that time, she couldnot hold objects in her hands, had
significant tremors and severe exhaustion.She also had several bad falls.
Since that time she had noticedarthralgiaon the right and subsequently on
the left side of her body. Then, the patient abruptly developed a right
hemisensory deficit after several days of work.The MRI scan was performed
at that time and revealeda multifocal white matter disease - areas of
increasedT2 signal in both cerebral hemispheres.Spinal tap was also done
which revealedthe presence of oligoclonal bands in CSF. Visual evoked
response testing was abnormal with slowedconduction in optic nerves.
1) the symptoms inthis patient's history that may lead you to suspect what
disease?
2)What other conditions can result in generalized white matter disease
evident on the MRI?
7. A 29-year-old man presentedwith a 10-day history ofsudden onset
generalizedheadache and 2 days of depressedmoodand apathy. They have
blerredvision,muscle spasms On examination.General systems and
neurological examinationreveals multiple scierosis.he has working ina
factory and he reaveledhe was cainsmoker.
1)howmany clinical types of multiple scierosis didyou know?
2)if this patient not treatedwhich adverse effects it leads to?

4. 8. Risk factors that increase the likelihood of developing progressive
multifocal leukoencephalopathy (PML) with the use of Natalizumab
include all the following except:
a. Treatment duration with Natalizumab
b. Anti-JC virus antibodies status
c. Disease duration
d. Prior use of immune-suppressant medication
9. A 58-year-old retiredfemale office clerkpresentedto the emergency
services muscle weakness onleft side , she had developed a cervical
transverse myelitis whichhad resolvedand then recurred2 years later
following which she was diagnosedwith multiple sclerosis.Over the next 4
years she had several relapses that all presented withcord symptoms
althoughbrain MRI also showed demyelination.She had receivedtreatment.
Then now she had consciousness,acute cognitive dysfunction, behavioral
changes, and seizures.
1)what is the presenting disease?
2)which viral diseases do you the triggeres ofthis disease?

5. 10. Which of the MRI parameters show the least correlation with
disability progression:
a. Chronic T1 black holes
b. T2 lesion burden
c. Brain atrophy
d. Spinal cord atrophy
11. A 38-year-old man presentedto the emergency department complaining
of unsteadiness and dizziness and a fall in which he suffered a minor head
injury withno loss of consciousness.No abnormality was found on
examinationand a skull X-ray was unremarkable. He re-presented1 week
later with a further minor head injury without loss of consciousness and
reportedongoing unsteadiness and dizziness,difficulty walking and blurred
vision, and was admittedto hospital.He workedas a chemistry laboratory
technician and occupied an office containing discarded experimental
equipment. Past medical history included investigationfor diarrhoeaand
possible malabsorbtion.Examinationrevealedsymmetrical incoordination
consistent withcerebellar dysfunctionand bilateral nystagmus on lateral
gaze.
1)the most likely diagnosis is ?
a)Myastheniagravis
b)Optic neuritis
c)nystagmus
d)optomolagy

6. 12. A 30-year-old Polishmanwas admittedto hospital with confusionand
aggressive behaviour.The history was obtained from friends. He had been
unwell for the previous 5 days with fever and headache and over the 2 days
prior to admissionhad sufferedseveral episodes of vomiting and
complainedof a stiff neck. He had been working in the UK as a labourer for
the preceding year and had not left the UK during that period. His wife had
remainedin Poland.None of his friends or workmates hadbeen unwell. He
had had one or two briefsexual relationships since his arrival in the UK.
There was no past medical history.
1)which diagnostic methodcan reveal this is meningitis are not fastly?
2)under lyning disease may be?
a)HIV
b)menengitis
c)Gonorrhea
13. A 70-year-old man developedepisodes of rhythmic shaking
(approximately 3Hz) ofthe left arm lasting for up to 2 minutes and
preceeded by a briefperiod of light-headedness.Occasionally,the left arm
shaking was accompanied by an odd feeling but no shaking in the left leg.
Attacks occurreda few times a week and were almost always triggeredby
standing up. Consciousness was never impaired.There was a history of
hypertensionand type II diabetes and he was taking metformin and
antihypertensive medication
1)this is due to complications of metformin?
a)True
b)false
2)what precaution do you suggest to this patient?
3)why those complications causing metformin?

7. 14. A 54-year-old male sales manager was admitted to hospital for
investigation of sudden
Headache, fever, confusion, stiff neck, vomiting. he has diagnosed with
syphilis.csf is taken for diagnosis.
1)what disease it will be?
2)what you will check in csf?
15. A 34-year-old male vet presented with a 5-day history of fatigue,
jaundice, decreased appetite, nausea, and inguinal lymphadenopathy.
Three days before admission, he noticed that his urine looked dark and
his left foot and the tips of his fingers felt numb and were tingling. The day
before admission,he developed a left facial droop and inability to close the
left eye. By the day of admission, the numbness and tingling had spread
upwards to involve the limbs as far as the knees and elbows, he felt short
of breath when talking, was unable to stand, and had choked on some
paracetamol. He complained of aching in his lower back. He had had no
contacts with jaundiced people, had not been abroad, had not received any
blood transfusions in the past, and was married. There was no past
medical history and he was a non-smoker and moderate drinker. He was
on no medication. ?
1)what is the disease causing those symptoms?