Neurology Main神经内科 11--课件.pptVIP

Neurology Main 11-20 Q 11A 36-year-old Caucasian male is brought to the emergency department due to weakness of his upper and lower extremities. Neurological examination reveals weakness, atrophy, fasciculations, spasticity and hyperreflexia of the involved muscles. His sensory, bowel， bladder and cognitive functions are intact. Serum creatine kinase is normal. Cerebrospinal fluid examination is within normal limits. Electromyography shows chronic partial denervation. The patient is subsequently diagnosed with amyotrophic lateral sclerosis. Which of the following has been approved for use in patients with amyotrophic lateral sclerosis?A. Riluzole B. Corticosteroids C. Intravenous immunoglobulins D. Plasmapheresis E. Donepezil A 11Correct answer:ARiluzole is a glutamate inhibitor that is currently approved for use in patients with amyotrophic lateral sclerosis. Although it cannot arrest the underlying pathological process, it may prolong survival and the time to tracheostomy. Its side effects are dizziness, nausea, weight loss, elevated liver enzymes and skeletal weakness.(Choices B, C D) Amyotrophic lateral sclerosis is a neurodegenerative disease. Corticosteroids: intravenous immunogiobuiins and cyclophosphamide have no role h its management. These agents are used in the management of immunologically-mediaied neurological diseases, such as multiple sclerosis and Guillain-Barre syndrome. Corticosteroids are used to treat acute exacerbations of multiple sclerosis, while plasmapheresis and intravenous 丨mmunoglobulins are the msin treatment modalities of Guillain-Barre syndrome.(Choice E) Donepezil is a cholinesterase inhibitor that is used to improve cognitive function in patients with Alzheimers disease. It has no role in the managemeni of amyotrophic lateral sclerosis.Educational Objective:Riluzole is a glutamate inhibitor that is currently approved for use in patients with amyotrophic lateral sclerosis. Q 12A 35-year-old man is brought to the emergency department