Q1. Is the medical management of unruptured AVMs better than interventional treatment?
A1. “Medical management alone remained superior to interventional therapy for the prevention of death or symptomatic stroke”
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Q2. What is the significance of double negative VGKC antibodies?
A2. “Double-negative VGKC complex antibodies…lack pathogenic potential and do not in themselves support the use of immunotherapies”
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Q3. What is the sinister implication of low titre anti-VGKC antibodies?
A3. “Low-level VGKC-complex antibodies…may serve as a marker of malignancy”
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Q4. Is tocilizumab effective for refractory autoimmune encephalitis?
A4. “Tocilizumab might be a good treatment strategy for treating autoimmune encephalitis refractory to conventional immunotherapies and rituximab”
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Q5. What is the clinical profile of seronegative limbic encephalitis?
A5. Seronegative patients are typically older men with short-term memory difficulties, seizures, impaired consciousness, or psychiatric symptoms
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Q6. What are the HLA risk factors for NMDAR autoimmune encephalitis?
A6. DRB1*16:02 allele was present in almost 15% of people with this disorder, compared to just under 5% of control subjects
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Q7. What are the distinctive MRI features of myelopathy in neuro-Behcet’s disease?
A7. The ‘bagel sign’ pattern: a central typically longitudinally extensive spinal cord hypointense lesion surrounded by a rim of hyperintensity
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Q8. How does the size of the third ventricle predict neuro-Behcet’s disease?
A8. The width of the third ventricle “is a highly sensitive candidate biomarker of early diagnosis and treatment efficacy” of neuro-Behcet’s disease
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Q9. What is the relationship of BPPV to vitamin D deficiency?
A9. Subjects with BPPV have significantly lower vitamin D levels than control subjects without BPPV
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Q10. Are steroid injections better than wrist splints for carpal tunnel syndrome?
A10. Steroid injections should be “the treatment of choice for rapid symptom response in mild or moderate carpal tunnel syndrome presenting in primary care”
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***
Q11. What factors predict recurrent lobar intracerebral haemorrhage from cerebral amyloid angiopathy (CAA)?
A11. Recurrent ICH was associated with subarachnoid haemorrhage and the presence of APOE ɛ4 gene mutations
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Q12. What are the risk factors for multiple intracranial aneurysms?
A12. There was a strong association between multiple aneurysms and female sex, older age, hypertension, smoking, and a family history of aneurysms
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Q13. Does aspirin increase the risk of bleeding from cerebral aneurysms?
A13. Aspirin use significantly decreased the risk of first-time aneurysm rupture, but it increased the risk of re-rupture
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Q14. Is the growth of cerebral aneurysms predictable?
A14. Aneurysm growth is predicted by its location, size and shape, early subarachnoid haemorrhage, and age >60 years
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Q15. Do statins reduce the risk of intracranial aneurysm rupture?
A15. Statins significantly reduce the risk of cerebral aneurysm rupture
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Q16. How does physical activity influence the risk of cerebral aneurysm rupture?
A16. Amount of weekly leisure-time and commuting activity was associated with a lower risk of aneurysm rupture especially in smokers
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Q17. Do developmental venous anomalies (DVAs) increase the bleeding risk of cavernomas?
A17. The risk of bleeding of brainstem cavernomas is reduced by the presence of an associated DVA
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Q18. Is stereotactic radiosurgery (SRS) beneficial for cavernomas?
A18. The outcome of people who had SRS was not better than the outcome in those who were not so treated
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Q19. How frequently does cervical artery dissection recur?
A19. The risk of early recurrence is about 60-fold, and this was not predicted by the presence of associated underlying connective tissue disease
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Q20. Are steroids effective in the acute treatment of cluster headache?
A20. Prednisone was an effective short-term preventative treatment for cluster headache
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***
Q21. What are the evidenced-based preventative measures for Alzheimer’s disease?
A21. Evidenced recommendations are the reduction of obesity, depression, stress, diabetes, hypertension and homocysteinaemia
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Q22. How does the weather influence the risk of seizures?
A22. Low atmospheric pressure and a relative air humidity > 80% increased the risk of recurrent seizures
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Q23. How do hand postures localise the site of seizure onset in epilepsy?
A23. Frontal lobe seizures were significantly associated with fist and pointing hand postures, and temporal lobe seizures with cup, politician’s fist, and pincer hand postures
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Q24. How does the 10/20 rule differentiate syncope from seizures?
A24. Convulsive syncope presents with < 10 jerks, whilst convulsive seizures manifests with >20 jerks
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Q25. Which HLA markers predict adverse skin reactions to oxcarbazepine?
A25. HLA-B*40:02 and HLA-DRB1*04:03 are significantly associated oxcarbazepine hypersensitivity
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Q26. How does valproate affect male reproductive function?
A26. Valproate significantly reduces the levels of follicular stimulating hormone (FSH) and testosterone
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Q27. How much higher is the risk of SUDEP in those who sleep alone?
A27. There was a 5-fold increased SUDEP risk in subjects who live and sleep alone
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Q28. How frequently do cranial autonomic symptoms (CAS) occur in migraine?
A28. 74% of people with migraine report at least one CAS
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Q29. How often does essential tremor co-exist with Parkinson’s disease?
A29. Essential tremor is co-morbid with Parkinson’s disease in almost 70% of cases
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Q30. How effective is gamma knife radiosurgery for essential tremor?
A30. 93% of patients reported improvement in their tremor following gamma knife radiosurgery
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***
Q31. Do statins delay the motor progression of Huntington’s disease (HD)?
A31. “Statin use was associated with a delayed motor diagnosis of HD”
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Q32. Does idiopathic intracranial hypertension (IIH) increase the risk of cerebrovascular events?
A32. Women with IIH had a two-fold higher risk for all cardiovascular outcomes
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Q33. Does warfarin cause worse intracranial bleeding than other anticoagulants?
A33. There was no difference between the two regarding the size or risk of expansion of bleeding, or in mortality and functional outcomes
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Q34. Do oral contraceptives increase the risk of stroke in people with migraine?
A34. The risk of stroke was increased 6-fold in women who have migraine with aura and also took combined oral contraceptives
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Q35. Does diabetes protect against migraine?
A35. “Both type 1 and type 2 diabetes were significantly associated with a decreased risk of migraine”
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Q36. What is the evidence for acupuncture in migraine prophylaxis?
A36. “Acupuncture may be at least similarly effective as treatment with prophylactic drugs”
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Q37. Which treatment confers the lowest relapse risk in anti-MOG antibody disease?
A37. Intravenous immunoglobulins (IVIg) had the lowest long-term annualised relapse frequency at 20%
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Q38. Is physical activity a risk factor for developing motor neurone disease (MND)?
A38. There was a linear correlation between leisure-time and occupational physical activity with the risk of developing MND
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Q39. Is the risk of motor neurone disease (MND) increased in professional football players?
A39. Professional soccer players had a higher risk of developing MND than the general population
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Q40. What is the risk of melanoma in people with C9orf72 variant motor neurone disease (MND)?
A40. “Patients with a history of melanoma may have an increased probability of carrying a C9ORF72 repeat expansion”
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Q41. What is the brain MRI signature of pre-symptomatic c9orf72 carriers?
A41. They have abnormal gyrification patterns in the left frontal and right parieto-occipital regions
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Q42. What is the benefit of vitamin D supplementation in the treatment of multiple sclerosis (MS)?
A42. Correcting vitamin D deficiency results in a reduction in the annual relapse rate of MS
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Q43. Does head injury increase the risk of developing multiple sclerosis (MS)?
A43. Adolescent concussion increased the risk of developing MS, and the risk correlated with the number of concussions
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Q44. Do vaccinations increase the risk of developing multiple sclerosis (MS)?
A44. Vaccinations do not increase the risk MS. Rather, vaccinations reduce the 5-year risk of an MS diagnosis
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Q45. How strong is the link between Epstein Barr virus (EBV) and multiple sclerosis (MS)?
A45. “A negative EBV serology in patients with suspected inflammatory central nervous system disease should alert clinicians to consider diagnoses other than MS”
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Q46. How does multiple sclerosis threaten cardiac conduction?
A46. 16% of MS subjects had a prolonged QTc interval
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Q47. Is multiple sclerosis (MS) a risk factor for myocardial infarction?
A47. There was a 60% higher hazard risk of acute myocardial infarction in subjects with MS compared to control subjects
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Q48. Which MRI features differentiate tumefactive multiple sclerosis (TMS) from brain tumours?
A48. TMS lesions often have incomplete rim enhancement and incomplete peripheral diffusion restriction
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Q49. Are intravenous steroids better than oral steroids in treating optic neuritis?
A49. There were no significant differences in visual function recovery between the two
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Q50. How does drinking cold water affect the exercise tolerance of people with multiple sclerosis (MS)
A50. “Cold-water ingestion enhanced exercise tolerance of MS participants in the heat by ~30%”
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***
Q51. Which drug mitigates the autoimmune side effects of alemtuzumab?
A51. Low dose rituximab after the first or second dose of alemtuzumab may be an effective strategy in minimising the risk of alemtuzumab-associated secondary autoimmunity
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Q52. What are the most prognostic factors of multiple sclerosis (MS) clinical progression?
A52. Low vitamin D levels and smoking predicted MS disease progression the most
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Q53. What are the brain MRI abnormalities in people with myotonic dystrophy?
A53. White matter hyperintensities were present in 70% of cases compared to 6% of control subjects
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Q54. Does myotonic dystrophy increase the risk of cancer?
A54. The risk of cancer in myotonic dystrophy is increased 1.8-fold, and this is greater in women
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Q55. Should Lamotrigine be the first line treatment for myotonia?
A55. Lamotrigine significantly and safely improved myotonia compared to placebo
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Q56. What are the intracranial vascular anomalies of late onset Pompe disease?
A56. >60% of subjects had unruptured aneurysms, vertebrobasilar dolichoectasia, or basilar artery fenestration
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Q57. How effective is rituximab in refractory myasthenia gravis?
A57. “Rituximab led to a sustained clinical improvement with prolonged time to relapse”
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Q58. Is stem cell transplantation effective for refractory myasthenia gravis?
A58. Stem cell transplantation gave “durable, symptom-free, and treatment-free remission”
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Q59. Is thymectomy beneficial for myasthenia gravis if the thymus gland is normal?
A59. “Thymectomy improved clinical outcomes over a 3-year period in patients with non-thymomatousmyasthenia gravis”
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Q60. What are the distinctive features of HEV-associated neuralgic amyotrophy?
A60. HEV-associated neuralgic amyotrophy was more likely to be bilateral, and more likely to involve the lumbosacral plexus and the phrenic nerve
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***
Q61. Does aquaporin 4 antibody status predict treatment response in neuromyelitis optica (NMO)?
A61. The aquaporin 4 status of NMO subjects did not influence their response to treatment
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Q62. How does pregnancy influence the course of neuromyelitis optica (NMO)?
A62. There is an increased rate of NMO relapses in pregnancy and in the first three months postpartum
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Q63. What are the distinctive features of paraneoplastic neuromyelitis optica (NMO)?
A63. Subjects with paraneoplastic NMO were more likely to be male; to be older at symptom onset; and to present with severe nausea and vomiting
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Q64. What features distinguish the longitudinally extensive myelitis of aquaporin 4 neuromyelitis optica (NMO)?
A64. It is more likely to involve the cervico-medullary junction, to show bright spotty lesions, and to expand the cord
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Q65. How do methotrexate and mycophenolate compare in the treatment of neurosarcoidosis?
A65. “Methotrexate significantly increases the survival time without relapse compared to mycophenolate”
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Q66. Are large volume spinal taps necessary to diagnose normal pressure hydrocephalus (NPH)?
A66. There is no relationship between the volume of CSF removed and subsequent gait test performance
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Q67. How is normal pressure hydrocephalus (NPH) associated with Alzheimer’s disease (AD)?
A67. NPH subjects who significantly improved after spinal fluid drainage also had a neurodegenerative CSF analysis pattern consistent with AD
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Q68. What is the relationship of normal pressure hydrocephalus (NPH) to vascular risk factors?
A68. NPH is independently associated with hyperlipidemia, diabetes, and obesity
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Q69. Does diabetes increase the risk of developing Parkinson’s disease?
A69. Diabetes “may predispose toward a Parkinson-like pathology” and “can induce a more aggressive phenotype”
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Q70. Does Parkinson’s disease (PD) increase the risk of stroke?
A70. “PD was associated with a significantly increased risk of stroke”
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Q71. What is the potential of glitazones in the prevention of Parkinson’s disease (PD)?
A71. Subjects with diabetes on glitazones had a significantly lower risk of developing PD than those who did not take glitazones
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Q72. Is obesity a risk factor for peripheral neuropathy?
A72. Peripheral neuropathy is prevalent in obese individuals even if their blood glucose is normal
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Q73. What surgical operations are most likely to trigger Guillain Barre syndrome (GBS)?
A73. GBS is “more strongly associated with bone and digestive organ surgery”
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Q74. Is chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) associated with cancer?
A74. CIDP is most frequently associated with non-Hodgkin’s lymphoma followed by other haematological malignancies and melanoma
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Q75. Is blood monitoring useful for patients on intravenous immunoglobulin (IVIg) therapy?
A75. Monitoring did not detect any clinically significant immunoglobulin-related adverse events
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Q76. What is the long-term benefit of tafamidis in familial amyloid polyneuropathy (FAP)?
A76. Tafamidis “does not prevent the steady progression of the neuropathy on the long term” in people with FAP
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Q77. Is serum GFAP helpful in distinguishing organic from functional seizures?
A77. Serum GFAP levels were significantly higher in subjects with epileptic seizures than in those with functional seizures
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Q78. What is the mortality risk of functional seizures?
A78. The standardised mortality ratio is 2.5 times higher than in the general population, and those < 30 years have an 8-fold higher risk of death
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Q79. Is high-dose methylprednisolone beneficial after traumatic spinal cord injury (SCI)?
A79. High-dose methylprednisolone does not improve the motor or sensory function of people with acute SCI
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Q80. Is rituximab any good for stiff person syndrome (SPS)?
A80. There is “no statistically significant difference in the efficacy measures between rituximab and placebo” in people with SPS
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Q81. How does pregnancy influence the course of stiff person syndrome (SPS)?
A81. Stabilisation or improvement of symptoms occurs in more than 50% of pregnancies; the reverse occurs post-partum
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Q82. Do artificial sweeteners increase the risk of stroke?
A82. Subjects with high consumption of artificially sweetened beverages are significantly more likely to develop stroke
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Q83. What are the predictors of atrial fibrillation (AF) in people with cryptogenic stroke?
A83. Premature atrial contractions and high thyroid stimulating hormone levels predict the presence of AF
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Q84. How often is the MRI normal following minor ischaemic stroke?
A84. A third of people with minor stroke had DWI-negative MRI scans
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Q85. How often is the MRI normal following major ischaemic stroke?
A85. Just < 7% of acute stroke cases are DWI-MRI negative. Posterior circulation strokes are 5 times more likely to be DWI negative
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Q86. Is stroke prevention indicated for people with small vessel disease?
A86. The Stroke Council of the American Heart Association advises that “primary stroke prevention is indicated in patients with silent brain infarcts, white matter hyperintensities, or microbleeds”
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Q87. How does the intracranial bleeding risk of rivaroxaban compare with dabigatran?
A87. Rivaroxaban 20mg daily significantly increased the risk of intracerebral and major extracranial bleeding compared to dabigatran 150mg twice a day
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Q88. Is thrombolysis beneficial when time of stroke onset is unknown?
A88. The outcome of patients whose time of stroke onset was unknown is more favourable if they were thrombolysed
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Q89. How does small vessel disease (SVD) influence the outcome of stroke thrombolysis?
A89. SVD “negatively affects stroke outcomes after intravenous thrombolysis”
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Q90. Is tenecteplase better than alteplase during thrombectomy for stroke?
A90. Tenecteplase successfully achieved reperfusion in 22% of subjects compared to alteplase which was successful in just 10% of subjects
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Q91. What are the major adverse effects of mechanical thrombectomy for stroke?
A91. Thrombectomy increased the risks of recurrent strokes, subarachnoid haemorrhage, and vasospasm
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Q92. How is the heart affected in transient global amnesia (TGA)?
A92. 8% of subjects with TGA had elevated cardiac troponin levels, and almost 7% had prolonged QTc intervals
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Q93. What does the MRI show in transient global amnesia (TGA)?
A93. 70% of subjects with TGA had DWI-MRI lesions in the hippocampus
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Q94. Is levetiracetam better than phenytoin in preventing seizures after traumatic brain injury (TBI)?
A94. The current evidence does not favour one drug over the other in the prophylaxis of seizures following severe TBI
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Q95. Is hypertonic saline better than mannitol for traumatic brain injury (TBI)?
A95. Hypertonic saline “appears to be superior to mannitol in reduction of the combined burden of intracranial hypertension and associated hypoperfusion in severe TBI patients”
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Q96. Which Parkinson’s disease drugs are safe to use in pregnancy?
A96. “Levodopa, rasagiline, pramipexole, and ropinirole alone or in combination with each other may be considered relatively safe during pregnancy”
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Q97. Which antihypertensive drugs have the best effect on white matter hyperintensities (WMH) in people with small vessel disease (SVD)?
A97.“Angiotensin-converting enzyme inhibitor was most consistently associated with less WMH progression independent of blood pressure control and age”
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Q98. What is the most important predictor of refractory genetic epilepsy?
A98. The most important prognostic factor for refractory seizures was resistance to valproic acid
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Q99. Is amantadine beneficial in the treatment of the minimally conscious state (MCS)?
A99. Amantadine 100–200 mg bid hastens functional recovery and reduces early disability in adults with traumatic MCS
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Q100. What is the place of non-invasive vagus nerve stimulation (VNS) in the treatment of primary headaches?
A100. Non-invasive VNS should be considered a first-line treatment for both acute and preventive treatments of cluster headache and migraine
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