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Cryptococcal meningitis — SCE Neurology MCQ

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HardCNS InfectionsCryptococcal meningitisSCE Neurology

A smoker has proximal facilitation, autonomic symptoms and a cerebellar syndrome; P/Q-type VGCC antibodies and small-cell lung cancer are confirmed. Which treatment expectation is most accurate?

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Correct answer: E — Amifampridine may improve the Lambert–Eaton weakness more reliably than the cerebellar ataxia

Explanation lettering: E = shown as A · D = shown as B · A = shown as D · B = shown as E

B is correct: VGCC antibodies can produce both LEMS and paraneoplastic cerebellar degeneration, but amifampridine improves presynaptic acetylcholine release and therefore the neuromuscular-junction syndrome much more reliably than the cerebellar process. A overgeneralises a shared biomarker. C acts postsynaptically and has modest LEMS benefit, not a selective cerebellar effect. D treats the wrong mechanism. E ignores the driving malignancy and overstates the durability of immune therapy.

Reference: Paraneoplastic neurological syndromes: a practical approach to diagnosis and management: https://pn.bmj.com/content/22/1/19