In patients with delirium due to hepatic failure which of the following EEG change may be seen?
E. Slow triphasic waves are typically seen in metabolic encephalopathies such as hepatic failure. Hypsarrhythmia is associated with infantile spasms (West’s syndrome). Three-Hz spikeand-wave activity associated with typical absence attacks. Generalized multiple spikes and waves (poly-spike wave) are associated with myoclonic epilepsy. In most cases of delirium, generalized slowing is noted. In delirium tremens and delirium due to withdrawal of sedatives, fast-frequency EEG may be obtained.
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Which of the following suggests a successful seizure activity after ECT?
B. EEG during ECT treatment shows sharp waves and spikes during the seizure. This must be recorded equally well on both EEG electrode leads to be confident of a generalized seizure activity. Clearly observable cessation point and good postictal suppression (flattening) are other features aiding confirmation of ictal activity on electric stimulation. See-saw pattern in sleep EEG is noted during REM sleep.
In neurological examination, which of the following is seen in hypothyroidism?
C. A characteristic neurological feature associated with hypothyroidism is delayed relaxation of deep tendon reflexes. This produces a slow and sluggish reflex. Hypertonia occurs in upper motor neurone lesions. Clonus is a sign of extremely brisk deep tendon reflex, often demonstrated at the ankles. It is a pyramidal sign. Loss of deep tendon reflexes should raise suspicion of a lower motor neurone lesion, for example motor neuropathy. Exaggerated jaw jerk is seen in pseudobulbar palsy, which can occur in motor neurone diseases such as amyotrophic lateral sclerosis.
Which one of the following patients is not suitable for undergoing MRI investigation when required?
C. Insertion of cardiac pacemaker precludes MRI study as the magnetic fi eld can disturb the pacemaker rhythm. Increased iron content, as in haemochromatosis, has no effect on MRI clinically! Due to the absence of exposure to radiation of X-ray frequency, pregnancy is not a contraindication to undergo MRI scanning. Patients with a signifi cant degree of claustrophobia might experience intense anxiety while undergoing MRI scan within the closed space of a scanner as undergoing MRI scanning is a more time consuming process than a plain X ray. Learning disability or epilepsy per se are not contraindications for MRI.
Which of the following is the most clinically useful method of diagnosing Alzheimer’s disease?
A. Various guidelines exist for diagnosing dementia. Most of them endorse routinely using clinical interview, especially on the lines of the DSM Definition of Dementia, for making a diagnosis of dementia. To specify subtypes of dementia, guidelines from consortium for DLB, consensus criteria for FTD, consensus for CJD, or Hachinski ischaemic index for vascular dementia may be useful. Sophisticated imaging techniques are not necessary for clinical diagnosis of dementia, for example volumetric MRI or CT measurement strategies.
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