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How Good at Neurology are you? – Answers
  1. Paul Goldsmith*,
  2. Graham Lennox*,
  3. Julian Ray
  1. *Department of Neurology and
  2. Department of Neurophysiology, Addenbrooke’s Hospital, Cambridge, UK. Email; pg255{at}; drslennox{at}; j.l.ray{at}



  • (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.


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