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How Good at Neurology are you? – Answers

^* Department of Neurology and
Department of Neurophysiology, Addenbrooke’s Hospital, Cambridge, UK. Email; pg255{at}hermes.cam.ac.uk; drslennox{at}aol.com; j.l.ray{at}medschl.cam.ac.uk

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1.

• (ii)
  
• (iii)
  
• (i)
  
• (iv) and perhaps (i)
  
• (v)
  

• Mild allergic reactions to IVIg are common. Anaphylactic reactions are rare and occur mostly in patients with an underlying IgA deficiency. Also, IVIg may occasionally lead to renal damage.
  
• Methotrexate causes interstitial fibrosis and should be avoided if there is already interstitial lung disease.
  
• Allopurinol inhibits xanthine oxidase, leading to decreased breakdown of azathioprine. Accumulation and eventual myelosuppression results, unless the dose of azathiorpine is appropriately lowered to 25% of usual, with particularly close monitoring.
  
• Cyclosporine causes dose-dependent nephrotoxicity, particularly in patients with pre-existing renal failure and hypertension.
  
• Cyclophosphamide can cause a severe and potentially fatal haemorrhagic cystitis and so should be avoided if bladder inflammation is already present.
  

Further reading:

Chevrel, Goebels & Hohlfeld. (2002) Myositis: diagnosis and management. Practical Neurology, 2, 4–11.

The British National Formulary. http://www.bnf.org

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