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Todd's Paresis – Lateralising — SCE Neurology MCQ

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HardEpilepsy & Seizure DisordersTodd's Paresis – LateralisingSCE Neurology

A man with MND has orthopnoea and non-refreshing sleep. PaCO2 is 5.8 kPa, FVC is 84% predicted and SNIP is 61 cmH2O. Which interpretation best follows NICE thresholds?

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Correct answer: D — The symptomatic SNIP threshold is breached; discuss ventilation-service referral and nocturnal assessment

Explanation lettering: D = shown as B · B = shown as C · C = shown as D

C is correct. In a symptomatic man, SNIP below 65 cmH2O meets the NICE symptom-linked threshold even though FVC is above 80%; nocturnal oximetry or limited sleep study and ventilation-service assessment are appropriate. A ignores the higher symptom-linked thresholds. B confuses the unconditional 40 cmH2O threshold with the symptomatic one. D and E falsely use normal daytime gas or absent dyspnoea to exclude nocturnal disease.

Reference: NICE NG42 — motor neurone disease recommendations: https://www.nice.org.uk/guidance/ng42/chapter/Recommendations