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DLB – Cautious Levodopa Trial — SCE Neurology MCQ

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HardNeurodegenerative DiseaseDLB – Cautious Levodopa TrialSCE Neurology

A 72-year-old woman with advanced dementia with Lewy bodies develops severe parkinsonism with rigidity and bradykinesia impairing her mobility and comfort. What is the appropriate approach to treating her parkinsonism?

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Correct answer: B — A cautious trial of low-dose co-careldopa, monitoring for worsening of visual hallucinations and psychiatric symptoms

The best answer is “A cautious trial of low-dose co-careldopa, monitoring for worsening of visual hallucinations and psychiatric symptoms”. UK stroke guidance supports urgent vascular imaging and reperfusion selection, short-course dual antiplatelet therapy for eligible minor stroke or high-risk TIA, decompression for life-threatening swelling, and secondary prevention matched to mechanism. The alternatives “Start high-dose levodopa immediately, when the phenotype supports it, within the relevant UK pathway”, “Start ropinirole, within the relevant UK pathway, after excluding important mimics, after specialist assessment”, “Start anticholinergic medication (trihexyphenidyl), after excluding important mimics, after specialist assessment, when the phenotype supports it”, “Parkinsonism should not be treated in DLB, after specialist assessment, when the phenotype supports it” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: National Clinical Guideline for Stroke: acute care: https://www.strokeguideline.org/chapter/acute-care/