The most reversible factor is HTN. It can be effectively managed with lifestyle changes like a healthy diet, exercise, stress reduction, and medications. Even small reductions in blood pressure significantly lower stroke risk. 

Incorrect options-

These options are comparatively less reversible.

• Diabetes has lasting vascular effects.
• Obesity reduces risk but is often difficult to maintain.
• Dyslipidemia can be managed but genetic factors remain.

Nerve supply of tongue-

Anterior 2/3-

• General sensation- Trigeminal nerve V3 via the lingual nerve.
• Taste - Facial nerve VII  via the chorda tympani.

Posterior 1/3-

• General sensation and taste- Glossopharyngeal nerve IX.

Base of tongue-

• General sensation and taste- Vagus nerve X.

Motor supply- 

• Hypoglossal nerve XII for all intrinsic and extrinsic muscles except platoglossus which is supplied by vagus nerve.

The patient has been seizure free for a year, indicating good control. Side effects like facial hair growth are distressing, making it reasonable to stop.

Migraines commonly cause unilateral headaches, unlike tension headaches, which are usually bilateral.

Migraines typically present at throbbing pain on one side of the head.

Incorrect option-

• Aura occurs before, not after the headache.
• Migraines can last longer than 4 hours.
• 30 minutes is too short for migraine.

A sudden, severe headache after lifting a heavy object suggests subarachnoid hemorrhage, often linked to HTN and ruptured blood vessels.

• Meningitis symptoms- Neck stifness, headache, and petechial rash point to bacterial meningitis.
• CSF findings- Elevated pressure supports diagnosis.

Neisseria meningitides is the most common cause in young adults.

A ruptured aneurysm is the most common cause of non- traumatic subarachnoid hemorrhage, leading to bleeding into the subarachnoid space.

Seizures can occur after a stroke, and anticonvulsants are used to prevent or control them.

 Incorrect options-

• Avoiding D5 50% prevents hyperglycemia which worsens brain injury.
• Diazepam is standard for stopping seizures.
• Correcting electrolytes is vital for recovery and preventing complications.

 BIH headaches are typically present on waking up or may awaken the patient. It could be accompanied by other signs of increased ICP like vomiting, papilledema, epilepsy or mental change.

Diazepam is the first choice for treating status epilepticus. If one doesn't stop the seizure, you can repeat it upto 40 mg in total.

Incorrect options-

• Phenytoin is used after benzodiazepines like diazepam fail.
• Phenobarbitone is another second-line option for seizures.
• Clonidine is for high pressure, not seizure.

Status epilepticus is when seizures continue for more than 30min or recur without the person waking up or regaining consiousness in between.

Migraine often starts with a sudden, severe headache that intensifies quickly. A history of mild headaches fits with typical migraine pattern, where the intensity increases over time.

Hyponatremia can cause neurological symptoms, but it's not the most common trigger for seizure compared to other electrolyte imbalance.

Naloxone is used to reverse opioid overdoses, like those from heroin or fentanyl, by blocking the effects of opioids on the brain and restoring normal breathing.

 We suspect meningitis, the treatment is antibiotic & lumbar puncture. The above mentioned options are not helpful in diagnosing and managing meningitis.

 Side effects of phenytoin:

• 1) CNS: cerebral edema, dysarthria & extrapyramidal syndrome
• 2) ENT: diplopia, nystagmus & tinnitus.
• 3) CVS: hypotension
• 4) GI: gingival hyperplasia & altered taste
• 5) GU: pink or red urine.
• 6) Dermatology: hypertrichosis & exfoliative dermatitis
• 7) Hematology: Agranulocytosis, aplastic anemia & macrocytic anemia
• 8) Other: Asteomalasia, Hypocalcaemia

All can cause peripheral neuropathy

Cluster headaches are intense, short-lived pains around the eye, often with symptoms like tearing, nasal congestion, eyelid swelling, and restlessness. 

Tension headaches often feel like a tight band around the head, and stress can make them worse. They can also cause pain around the eye.

High BP weakens the brain's blood vessels, making them more prone to rupture causing bleeding, which is the leading cause of intracerebral hemorrhage.

Vestibular neuritis is an inner ear infection that infalmes the balance nerve [vestibular], causing dizziness, nausea, and trouble with coordination.

As the frontal lobe controls behaviour, personality, and decision-making. Damage here can cause mood and behavioural changes.

Change in level of consiousness, as increased ICP affects brain function, leading to confusion, drowsiness, or unresponsiveness.

Incorrect options-

• Ipsilateral pupillary dilatation can be a sign of increased ICP but it's not the first symptom.
• Contralateral pupillary dilatation is similar to ipsilateral dilatation, it's not usually the initial sign.
• Hemiparesis is weakness of one side of the body and is not initial feature.

As we age, stiffer arteries lead to higher systolic BP, making isolated systolic HTN a bigger risk for heart attacks and strokes in older adults.

Temporal, as the tempotal lobe processes sensory information, including smell, and damage here can cause anosmia.

IV lorazepam, as it's the first-line tratment for stopping a prolonged seizure. Lorazepam works quickly by enhancing GABA, which calms the brain.

Carbamazepine, as it's the first-line treatment for trigeminal neuralgia. It helps by stabilizing nerve activity, providing effective pain relief.

Neurofibromatosis, a genetic disorder that can cause ataxia, skin pigmentation, and hearing loss. The family history supports the diagnosis.

Cerebellum, as its responsible for coordinating movement. Damage here can cause dysmetria, making it hard to bring spoon to the mouth.

Septra can trigger an attack of AIP.

Loss of cells, as Alzheimer's causes the gradual death of brain cells, particularly those involved in memory, leading to cognitive decline.

Bio feedback has been shown to help some people with migraines. Biofeedback is a technique that can give people better control over body function indicators such as blood pressure, heart rate, temperature, muscle tension, and brain waves. The two most common types of biofeedback for migraines are thermal biofeedback and electromyographic biofeedback.

Pseudobulbar palsy, which causes symptoms like spastic tongue, dysarthria, and uncontrollable emotional outbursts like crying. It happens due to damage to the upper motor neurons that control the muscles of the face and tongue.

Rifampicin, an antibiotic used to prevent meningitis in people who have had close contact with someone infected.

TPA: is administered within 3 hours of symptoms onset (if no contraindication).

Incorrect options-

• ASA: is used within 48 hours of ischemic stroke to reduce the risk of death.
• Clopidogrel: can be used in acute ischemic& an alternative to ASA.
• Heparin & other anticoagulants: in patient has a high risk of DVT or AF.

TOS, which involves compression of the nerves and blood vessels between the collarbone and the first rib. Symptoms often include neck stifness, numbness, and tingling in the fingers, with a positive raised hand test.

Tremors are usually the first symptom of Parkinson's disease, often starting as slight shaking in one hand and spreading to other parts of the body.

Incorrect options-

• Rigidity is a common symptom but typically comes after tremors.
• Unsteady gait appears later in disease.
• Hypotension can be a side effect of Parkinson's medication.

Bupropion can increase the risk of seizures, especially in individuals with history of seizures or certain health conditions.

Sumatriptan works quickly by narrowing blood vessels in the brain, providing rapid relief during an attack.

Beta-blockers are commonly used to treat both high BP and migraines. They help lower BP and can reduce the frequency and severity of migraines.

Antibody against acetylcholine receptors, which points to Myasthenia Gravis. This autoimmune disease attacks acetylcholine receptors, leading to muscle weakness, especially in muscles used for swallowing, eye movement causing diplopia andgeneral fatigue.

In sickle cell disease, the altered RBCs can block flow in small vessels, leading to multiple cerebral infarcts in the brain.

Alzheimer's disease is the most common cause of dementia, typically leading to gradual memory and cognitive decline, visual problems, and in some cases, personality changes. The brain CT showing cortical atrophy and ventricular dilatation fits the pattern of Alzheimer's.

Amyloid plaques and neurofibrillary tangles and are key features of Alzheimer's disease, disrupting communication between brain cells and leading to cognitive decline.

Alzheimer's is the most common form of dementia in older adults and often starts with gradual memory loss, difficulty concentrating, and disorganization, as described.

Incorrect options-

• Multi-infarct dementia is caused by multiple strokes, has a sudden onset and stepwise decline in cognitive abilities.
• Lewy body dementia includes features of hallucinations, Parkinson symptoms, and fluctuating cognition.
• Schizophrenia is a mental health disorder with hallucinations and delusions, but it typically occurs earlier in life.

Alzheimer's is the most common dementia, presenting with progressive memory loss and cognitive decline. CT findings of enlarged ventricles and cortical atrophy are classic indicators.

Beta blocker are used in prevention of migraine attack. It works by blocking the effect of certain chemicals in the body that trigger migraine.

A 6-month-old with fever should be given antipyretics to reduce the risk of febrile convulsions.

These features are indicating damage in the prefrontal area. The prefrontal cortex is key for impulse control, emotional regulation, and social judgement.

Dipyrimadole is safer for stroke prevention inpatients with history of gastric ulcers. It is an antiplatelet agent and reduces the risk of further strokes without significantly increasing the risk if GI bleeding compared to aspirin.

Alzheimer’s disease is primarily a clinical diagnosis. Based on the presence of characteristic neurological and neuropsychological features and the absence of an alternative diagnosis. It is commonly found in people over 65 presenting with progressive dementia for several years.

Tests used to investigate multiple sclerosis-

• Visual evoked potential assesses brain response to stimuli.
• Lumbar puncture analyzes CSF for inflammation.
• MRI detects brain and spinal cord leisons.

Skull X-ray, as it's not sensitive for causes like subarachnoid hemorrhage.

Paraplegia is not a feature of SAH, as it involves loss of sensation/movement below waist, which is unrelated to SAH.

The listed options are not primary treatments of SAH. 

SAH is usually treated with-

• Endovascular coiling or surgical clipping
• Supportive care to manage complications.
• Medications like nimodipine to prevent further brain damage.

The patient's history of bilateral morning headaches align with BIH, which is associated with increased intracranial pressure. OCP use is a known risk factor of BIH, as it can contribute to hormonal and pressure changes.

• The patient's vision loss and jaw claudication are calssic signs of temporal arteritis.
• Age is a significant risk factor, as this condition is more common in adults.

A CT scan is often the first test used to rule out other causes of dementia-like symptoms, such as stroke or brain tumors.

Dyskinesia refers to involuntary movements such as tics, tremors, or muscle twisting, and is a common side effect of levodopa,especially with long-term use or high doses.

When a patient has a first-time seizure, it's crucial to identify potential causes quickly. Lab results in ER help rule out immediate triggers like infections, electrolyte imbalances, low blood sugar, or toxins. These tests are fast and essential to guide further steps.

Breastfeeding is safe even while taking phenobarbital. The benifits of breastfeeding outweight the minimal risks, but it's important to monitor the baby for drowsiness or other side effects.

Sciatica occurs due to irritation or compression of the sciatic nerve, leading to symptoms like pain, numbness, or weakness in the leg including possible calf muscle weakness.

The occipital lobe processes visual information. A stroke affecting this area can cause vision loss including issues with visual fields like hemianopia.

Bell's palsy a temporary facial muscle weakness or paralysis, often begins to improve within two weeks. Most cases recover fully within few months.

Phenytoin can cause side effects, including hypersenstivity reactions, which may present as abdominal pain and lymph node enlargement.

These symptoms suggest carpal tunnel syndrome, caused by compression of the median nerve. Decompression surgery relieves pressure on the nerve and resolves the symptoms.

NMS is a serious reaction to antipsychotics, with symptoms like diaphoresis, hyperreflexia, muscle rigidity, fever and altered mental status.

This presentation is likely Bell's Palsy, which usually resolves on its own within weeks to months.

These symptoms strongly indicate meningococcal meningitis. The petechial rash and low CSF glucose are hallmark signs of this bacterial infection.

The Romberg sign tests balance by having a person stand with their eyes closed. If they sway or fall, it suggests a problem with proprioception. The dorsal column of the spinal cord carries proprioception signals to the brain. If it's damaged, it causes positive Romberg sign.

The sensory cortex processes proprioception signals. Damage here leads to a positive Romberg sign.

HTN is a common cause of intracranial hemorrhage. It puts extra pressure on the brain's blood vessels, making them more prone to rupture and causing bleeding inside the skull.

Lymphocytes increase as the body is fighting against viral infections.

These symptoms point towards a problem in occulomotor nerve, which controls eye movement. 

MS is an autoimmune disease where the body attacks the myelin sheath in the brain and spinal cord. This leads to inflammation and immune activity in CNS. The immune system produces IgG antibodies against myelin, which can be detected in CSF, this is hallmark of MS.

Incorrect options-

• Duchenne muscular dystrophy is a genetic disorder, not linked ti immune mediated IgG increase in CSF.
• Myasthenia gravis is an autoimmune disorder at the neuromuscular junction, but immunoglobulin is not elevated in CSF.
• Bell's palsy is a temporary facial nerve inflammation, not related to autoimmune IgG in CNS.

The temporal lobe is key for memory and recognizing familiar faces. In Alzheimer's, damage here leads to problem like not recognizing loved ones and emotional outbursts.

Incorrect options-

• Cerebellum is responsible for balance and coordination, not memory.
• Parietal lobe deals with sensory processing and spatial awareness.
• Occipital lobe focuses on vision, not recognition or emotions.

Aspirin is started immediately because it thins blood, prevents clot formation reducing the risk of another attack. Stroke is time-sensitive and should be managed as early as possible.

Increased pressure in the skull causes stretching and irritation of pain sensitive areas leading to a headache often the first noticeable sign.

Stress and muscle tension creates a band-like, dull pain around the head which is a classic sign of tension headache.

Severe headache and high ESR suggest giant cell arteritis, an inflammation of blood vessels. Corticosteroids quickly reduce this inflammation and prevent complications like vision loss.

The classic symptom of subarachnoid hemorrhage is thunderclap headache (a headache described as "like being kicked in the head", or the "worst ever", developing over seconds to minutes). This headache often pulsates towards the occiput (the back of the head).

Intracerebral Hemorrhage: Patients with intraparenchymal bleeds have symptoms that correspond to the functions controlled by the area of the brain that is damaged by the bleed.

•  Other symptoms include those that indicate a rise in intracranial pressure due to a large mass putting pressure on the brain. Intracerebral hemorrhages are often misdiagnosed as subarachnoid hemorrhages due to the similarity in symptoms and signs. A severe headache followed by vomiting is one of the more common symptoms of intracerebral hemorrhage. Some patients may also go into a coma before the bleeding is noticed.

Bupropion can trigger cluster headcahes in some individuals, so it should be avoided in these patients.

Phenytoin can cause painless lymph node swelling as a rare side effect without other symptoms. 

Excessive inward curvature of the lower back can put pressure on the sciatic nerve, increasing the risk of sciatica.

Benzodiazepines are calming medications that help slow down overactive brain activity. This makes them really useful for treating catatonia, which can cause behaviors like repeating other's words and mimicking their movements. They also help with related issues like anxiety and insomnia.

The spine and head X-rays show signs of possible multiple myeloma, a bone cancer that can spread to the chest. A chest X-ray helps check if the disease has affected the ribs or sternum.

Parkinson's cause tremors, shuffling gait, and cognitive impairment, which match the patient's symptoms of shaking hands and difficulty walking.

Pseudobulbar palsy results from an upper motor neuron lesion to the corticobulbar pathways in the pyramidal tract.

Patients have difficulty chewing, and swallowing and demonstrate slurred speech (often initial presentation). Individuals with pseudobulbar palsy also demonstrate inappropriate emotional outbursts.

S/S: 1) Speech is slow 2) thick and indistinct 3) Gag reflex is normal 4) exaggerated or absent 5) Tongue is small stiff and spastic 6) Jaw jerk is brisk 7) upper motor neuron lesion of the limbs 8) Dysphagia (difficulty in swallowing) 9) Labile affect 10) Dysarthria 11) Uncontrollable laughing or crying.

Bulbar palsy refers to bilateral impairment of the function of the lower cranial nerves IX, X, XI, and XII, which occurs due to lower motor neuron lesions either at a nuclear or fascicular level in the medulla oblongata or from bilateral lesions of the lower cranial nerves outside the brainstem.

S/S : 1) dysphagia (difficulty in swallowing) 2) difficulty in chewing 3) nasal regurgitation 4) slurring of speech 5) choking on liquids 6) Nasal speech lacking in modulation and difficulty with all consonants 7) Tongue is atrophic and shows fasciculations 8) Dribbling of saliva 9) Weakness of the soft palate, examined by asking the patient to say aah – 10) The jaw jerk is normal or absent 11) The gag reflex is absent 12) lower motor neuron lesions of the limbs.

Alzheimer's, the brain shrinks in multiple areas, not just one leading to memory loss, confusion, and other symptoms.

It works by narrowing blood vessels in the brain, which helps relieve migrane pain and symptoms. Other medications can help with general headache but are not as effective.

The correct treatment for ulnar nerve compression in this case is surgical cubital decompression. Surgery can relieve pressure and prevent further damage.

Varenicline drug used for smoking cessation is contraindicated in patients with a history of seizure.

High potassium levels disrupt electrical signals needed for muscle contraction, leading to weakness and, in severe cases, paralysis.

The best option for reducing the risk of post therapeutic neuralgia is valacyclovir. When started within 72 hours of the rash onset, Valacyclovir helps reduce the likelihood of persistent pain after the rash resolves.

Septra can trigger the attack of acute intermittent porphyria, a condition that affects the production of heme. This leads to symptoms like abdominal pain and muscle weakness.

Cluster headaches are indeed more common in men than women, making this a well established fact.

While tetanus causes muscle spasms and stiffness, its presentation is distinct from Guillian-Barre syndrome, which causes progressive weakness and numbness. Tetanus typically involves rigidity and difficulty swallowing, not the same pattern of muscle weakness is seen in Guillian-Barre.

MND also known as amyotrophic lateral sclerosis causes progressive muscle weakness, spasticity, and dysphagia while typically sparing eye muscles in the early stage.

The greatest single risk factor for stroke is HTN. HTN strains blood vessels, increasing the risk of both hemorrhagic and ischemic strokes by causing vessel rupture or promoting blood clots

The mot likely diagnosis is Myasthenia Gravis. This condition causes progressive muscle weakness, often affecting voluntary muscles, including those involved in swallong leading to dysphagia and decreased hand grip strength

This technique helps manage headaches, especially those linked to stress. By using sensors to monitor bodily functions like heart rate or muscle tension, patients can learn to control these functions and reduce headache triggers.

The most likely diagnosis is giant cell arteritis [GCA] and the treatment of choice is corticosteroids. 

The most likely diagnosis here is MND also known as Amyotrophic Lateral Sclerosis [ALS]. This condition involves progressive muscle weakness, spasticity, fasciculations, and dysphagia, all of which match the patient's symptoms. Diplopia can occur due to weak eye muscles in MND.

Tension-type headache: constant pressure, frequent bilateral; a/w myofacial sensitivity in neck or head.

• Triggers: stress, sleep, deprivation, dehydration, hunger.
• TTT: OTC analgesics (NSAID, acetaminophen; risk of med overuse HA) for episodic; TCAs for chronic.

Methysergide was once used for preventing cluster headaches, but it ahs been largely discontinued due to serious side effects including heart valve damage and fibrosis.

Parkinson's is characterized by symptoms like a resting tremor , bradykinesia, abnormal gait, and fatigue, which match the symptoms described in this case.

Alzheimer's disease is primarily characterized by the progressive death of brain cells, which leads to formation of amyloid plaques and neurofibrillary tangles.These disrupt communication between brain cells and result in the cognitive decline associated with Alzheimer's.

In GBS weakness usually begins in the lower limbs and ascends upwards towards the trunk and arms, which is a key feature of this condition.

Alzheimer's is characterized by gradual memory loss and cognitive decline due to brain cell death, leading to the formation of amyloid plaques and neurofibrillary tangles.

Incorrect options-

• Multi infarct dementia is caused by multiple small strokes, leading to stepwise cognitive decline.
• Parkinsonism primarily affects motor functions, causing tremors, bradykinesia, and rigidity, not memory.

Beta-blockers reduce the heart rate, making them useful for preventing migraine by reducing overall stress on your body.

A cluster headache is an intense one sided pain around the eye, often waking you up at night. It may also cause eye watering and drooping.

When frontal sinus gets infected, the infection can spread to brain causing abscess. That is why frontal sinusitis is important to consider when someone has a brain abscess.

EPS are movement disorders that occur due to dysfunction in the extrapyramidal system, which is involved in coordination of movement. Thses symptoms are commonly associated with antipsychotic medications and other drugs that block dopamine receptors.

Careful history and examination are essential for diagnosing migraine.

Unilateral headache which is pulsatile and increases on exposure to light and sound is indicative of migraine.

Aspirin is an antiplatelet that inhibits cyclooxgenase, reducing thromboxane A2 and platelet aggregation, which further helps prevent clot formation and reduces the risk of ischemic damage during an acute ischemic stroke.

AF is a common cause of embolic stroke due to irregular rhythms that can lead to blood clot formation in the atria, which can travel to brain.

During a seizure its crucial to keep the airway open. An airway device helps prevent choking and ensures breathing.

Diazepam is the drug of choice and can be given a maximum of 40mg

RLS is a neurological disorder characterized by an irresistible urge to move one's body to stop uncomfortable or odd sensations. It most commonly affects the legs but can affect the arms & torso.

• Symptoms: urge to move - worsening of symptoms by relaxation - worse in the evening and early in the night.
• Treatment: Dopamine agonists “Ropinirole, Pramipexole or gabapentin enacarbil” as first-line drugs for daily restless legs syndrome; and opioids for treatment of resistant cases.

Neisseria meningitides is a bacterium that causes bacterial meningitis, especially in close contact environments like dormitories. It is spread through respiratory droplets and can lead to severe infection of the meninges.

All the options mentioned above are a part of CFS.

Pudendal nerve entrapment occurs when the pudendal nerve, which supplies sensation to the genital area, becomes compressed or pinched, often due to prolonged sitting. This leads to symptoms like genital numbness and pain.

Chronic Fatigue Syndrome:

characterized by profound mental and physical exhaustion, in association with multiple systems and neurotic symptoms that last at least 6 months.

• Must be new (not lifelong), must not be relieved by rest, and must result in greater than 50% reduction in previous activity.
• Presentation with 4 or more: poor memory/ concentration, myalgia, arthralgia, sore throat, tender lymph node, recent onset headache, unrefreshing sleep, excessive tiredness with exercise.
• Treatment by cognitive and exercise therapy. Also, diet, physiotherapy, dietary supplements & antidepressants.

Biofeedback is the best method if she doesn't want regular medication.

Frontal lobe is responsible for personality, decisions, and soical behavior. When it's damages it can lead to agression.

D/D of proximal muscle weakness:

• Myasthenia Gravis and Lambert Eaton Syndrome- both have ocular symptoms with proximal muscle weakness.
• Endocrinopathies- hypo/hyperthyroidism, adrenal insufficiency.
• Drug-induced- steroid, statins, cyclosporine.
• Inflammatory myopathies- dermatomyositis, polymyositis

None of the options are correct.

Trigeminal neuralgia causes sudden, stabbing pain in the face due to overactive nerves. Oxcarbazepine helps calm these nerves, relieving pain.

Brainstem damages can disrupt breathing control, leading to build-up of CO2 in blood.

Drug induce amenorrhea refers to the cessation of menstruation caused by medications that alter hormone levels, such as those used in hormone therapy or birth control. This can mimic pregancy which in some cases , may alleviate headache symptoms, especially thise related to hormonal fluctuation, as seen in tension headache.

Tarsal tunnel syndrome occurs when the tibial nerve is compressed as it passes through a narrow space in ankle. This leads to symptoms like pain, numbness, and tingling in the foot.