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


1. Please consider the following:

A 53-year-old lady developed a subacute flaccid quadriparesis and bilateral facial weakness. A diagnosis was made and treatment initiated. Her strength began to improve, but a week later she developed sudden onset left sided weakness. The following investigations were carried out:

  • Urgent CT brain scan: normal, but poor quality scan

  • Na 132 mmol/L, K 4.4 mmol/L, urea 7.2 mmol/L, creatinine 110 mmol/L, albumin 38 mmol/L, Ca 2.3 mmol/L, PO4 2.1 mmol/L, Hb 11.5 g/dL, white cell count 8.4 × 109/l, platelets 35 × 109/L.

What is the underlying cause of her deterioration?

  1. Paroxsymal nocturnal haemoglobinuria (PNH)

  2. Thrombotic thrombocytopenic purpura (TTP)

  3. Haemolytic uraemic syndrome (HUS)

  4. Heparin induced thrombocytopenia (HIT)

  5. Vasculitis

2. Please study the following image:

This man presented with headache and obscurations of vision. What is the underlying diagnosis?

(Copyright: Diepgen TL, Yihune G et al. Dermatology Online

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