Neurology question
and answers
2025/2026
A 70 year old man has decompressive surgery for degenerative cervical myelopathy. Three years
later he presents with neck pain and hand paraesthesias. Which one of the following
management strategies is recommended? - correct answersPostoperatively, patients with
cervical myelopathy require ongoing follow-up as pathology can 'recur' at adjacent spinal levels,
which were not treated by the initial decompressive surgery.
All patients with recurrent symptoms should be evaluated urgently by specialist spinal services
Degenerative cervical myelopathy - correct answersDegenerative cervical myelopathy (DCM)
has a number of risk factors, which include smoking due to its effects on the intervertebral
discs, genetics and occupation - those exposing patients to high axial loading [1].
DCM symptoms can include any combination of [1]:
Pain (affecting the neck, upper or lower limbs)
Loss of motor function (loss of digital dexterity, preventing simple tasks such as holding a fork or
doing up their shirt buttons, arm or leg weakness/stiffness leading to impaired gait and
imbalance
,Loss of sensory function causing numbness
Loss of autonomic function (urinary or faecal incontinence and/or impotence) - these can occur
and do not necessarily suggest cauda equina syndrome in the absence of other hallmarks of
that condition
Hoffman's sign: is a reflex test to assess for cervical myelopathy. It is performed by gently
flicking one finger on a patient's hand. A positive test results in reflex twitching of the other
fingers on the same hand in response to the flick.
Idiopathic intracranial hypertension associated medications include - correct answersAssociated
medications include, but are not limited to:
tetracycline antibiotics
isotretinoin
contraceptives
steroids
levothyroxine
lithium
cimetidine
Idiopathic intracranial hypertension (also known as pseudotumour cerebri and formerly benign
intracranial hypertension) is a condition classically seen in young, overweight females.
Risk factors
obesity
female sex
pregnancy
drugs*: oral contraceptive pill, steroids, tetracycline, vitamin A, lithium
Features
,headache
blurred vision
papilloedema (usually present)
enlarged blind spot
sixth nerve palsy may be present
Management
weight loss
diuretics e.g. acetazolamide
topiramate is also used, and has the added benefit of causing weight loss in most patients
repeated lumbar puncture
surgery: optic nerve sheath decompression and fenestration may be needed to prevent damage
to the optic nerve. A lumboperitoneal or ventriculoperitoneal shunt may also be performed to
reduce intracranial pressure
if intracranial hypertension is thought to occur secondary to a known causes (e.g. Medication)
then it is of course not idiopathic
Migraine: management - correct answersIt should be noted that as a general rule 5-HT receptor
agonists are used in the acute treatment of migraine whilst 5-HT receptor antagonists are used
in prophylaxis. NICE produced guidelines in 2012 on the management of headache, including
migraines.
Acute treatment
first-line: offer combination therapy with an oral triptan and an NSAID, or an oral triptan and
paracetamol
for young people aged 12-17 years consider a nasal triptan in preference to an oral triptan
, if the above measures are not effective or not tolerated offer a non-oral preparation of
metoclopramide* or prochlorperazine and consider adding a non-oral NSAID or triptan
Acute treatment
first-line: offer combination therapy with an oral triptan and an NSAID, or an oral triptan and
paracetamol
for young people aged 12-17 years consider a nasal triptan in preference to an oral triptan
if the above measures are not effective or not tolerated offer a non-oral preparation of
metoclopramide* or prochlorperazine and consider adding a non-oral NSAID or triptan
if these measures fail NICE recommend 'a course of up to 10 sessions of acupuncture over 5-8
weeks'
NICE recommend: 'Advise people with migraine that riboflavin (400 mg once a day) may be
effective in reducing migraine frequency and intensity for some people'
for women with predictable menstrual migraine treatment NICE recommend either frovatriptan
(2.5 mg twice a day) or zolmitriptan (2.5 mg twice or three times a day) as a type of 'mini-
prophylaxis'
pizotifen is no longer recommend. Adverse effects such as weight gain & drowsiness are
common
A man with a history of chronic alcohol abuse attends the Emergency Department. He is
unkempt, drowsy and confused, and it is believed he has not eaten in forty eight hours. A
decision to commence chlordiazepoxide PRN and IV Pabrinex is made. Which vitamin, present in
Pabrinex, can prevent progression of symptoms to Wernicke's encephalopathy? - correct
answersVitamin B1, also called thiamine, is essential for glial cells of the nervous system, as well
as other bodily systems. Deficiency can cause Wernicke's encephalopathy and if left untreated
can lead to irreversible Korsakoff's syndrome.
Wernicke's encephalopathy is a neuropsychiatric disorder caused by thiamine deficiency which
is most commonly seen in alcoholics. Rarer causes include: persistent vomiting, stomach cancer,
dietary deficiency. A classic triad of ophthalmoplegia/nystagmus, ataxia and confusion may
and answers
2025/2026
A 70 year old man has decompressive surgery for degenerative cervical myelopathy. Three years
later he presents with neck pain and hand paraesthesias. Which one of the following
management strategies is recommended? - correct answersPostoperatively, patients with
cervical myelopathy require ongoing follow-up as pathology can 'recur' at adjacent spinal levels,
which were not treated by the initial decompressive surgery.
All patients with recurrent symptoms should be evaluated urgently by specialist spinal services
Degenerative cervical myelopathy - correct answersDegenerative cervical myelopathy (DCM)
has a number of risk factors, which include smoking due to its effects on the intervertebral
discs, genetics and occupation - those exposing patients to high axial loading [1].
DCM symptoms can include any combination of [1]:
Pain (affecting the neck, upper or lower limbs)
Loss of motor function (loss of digital dexterity, preventing simple tasks such as holding a fork or
doing up their shirt buttons, arm or leg weakness/stiffness leading to impaired gait and
imbalance
,Loss of sensory function causing numbness
Loss of autonomic function (urinary or faecal incontinence and/or impotence) - these can occur
and do not necessarily suggest cauda equina syndrome in the absence of other hallmarks of
that condition
Hoffman's sign: is a reflex test to assess for cervical myelopathy. It is performed by gently
flicking one finger on a patient's hand. A positive test results in reflex twitching of the other
fingers on the same hand in response to the flick.
Idiopathic intracranial hypertension associated medications include - correct answersAssociated
medications include, but are not limited to:
tetracycline antibiotics
isotretinoin
contraceptives
steroids
levothyroxine
lithium
cimetidine
Idiopathic intracranial hypertension (also known as pseudotumour cerebri and formerly benign
intracranial hypertension) is a condition classically seen in young, overweight females.
Risk factors
obesity
female sex
pregnancy
drugs*: oral contraceptive pill, steroids, tetracycline, vitamin A, lithium
Features
,headache
blurred vision
papilloedema (usually present)
enlarged blind spot
sixth nerve palsy may be present
Management
weight loss
diuretics e.g. acetazolamide
topiramate is also used, and has the added benefit of causing weight loss in most patients
repeated lumbar puncture
surgery: optic nerve sheath decompression and fenestration may be needed to prevent damage
to the optic nerve. A lumboperitoneal or ventriculoperitoneal shunt may also be performed to
reduce intracranial pressure
if intracranial hypertension is thought to occur secondary to a known causes (e.g. Medication)
then it is of course not idiopathic
Migraine: management - correct answersIt should be noted that as a general rule 5-HT receptor
agonists are used in the acute treatment of migraine whilst 5-HT receptor antagonists are used
in prophylaxis. NICE produced guidelines in 2012 on the management of headache, including
migraines.
Acute treatment
first-line: offer combination therapy with an oral triptan and an NSAID, or an oral triptan and
paracetamol
for young people aged 12-17 years consider a nasal triptan in preference to an oral triptan
, if the above measures are not effective or not tolerated offer a non-oral preparation of
metoclopramide* or prochlorperazine and consider adding a non-oral NSAID or triptan
Acute treatment
first-line: offer combination therapy with an oral triptan and an NSAID, or an oral triptan and
paracetamol
for young people aged 12-17 years consider a nasal triptan in preference to an oral triptan
if the above measures are not effective or not tolerated offer a non-oral preparation of
metoclopramide* or prochlorperazine and consider adding a non-oral NSAID or triptan
if these measures fail NICE recommend 'a course of up to 10 sessions of acupuncture over 5-8
weeks'
NICE recommend: 'Advise people with migraine that riboflavin (400 mg once a day) may be
effective in reducing migraine frequency and intensity for some people'
for women with predictable menstrual migraine treatment NICE recommend either frovatriptan
(2.5 mg twice a day) or zolmitriptan (2.5 mg twice or three times a day) as a type of 'mini-
prophylaxis'
pizotifen is no longer recommend. Adverse effects such as weight gain & drowsiness are
common
A man with a history of chronic alcohol abuse attends the Emergency Department. He is
unkempt, drowsy and confused, and it is believed he has not eaten in forty eight hours. A
decision to commence chlordiazepoxide PRN and IV Pabrinex is made. Which vitamin, present in
Pabrinex, can prevent progression of symptoms to Wernicke's encephalopathy? - correct
answersVitamin B1, also called thiamine, is essential for glial cells of the nervous system, as well
as other bodily systems. Deficiency can cause Wernicke's encephalopathy and if left untreated
can lead to irreversible Korsakoff's syndrome.
Wernicke's encephalopathy is a neuropsychiatric disorder caused by thiamine deficiency which
is most commonly seen in alcoholics. Rarer causes include: persistent vomiting, stomach cancer,
dietary deficiency. A classic triad of ophthalmoplegia/nystagmus, ataxia and confusion may
