The Legislature, in codifying the discovery rule

The Legislature, in codifying the discovery rule, has also required plaintiffs to pursue their claims diligently by making accrual of a cause of action contingent on when a party discovered or should have discovered that his or her injury had a wrongful cause. (E.g., Code Civ. Proc., �� 340.1, subd. (a) [""within three years of the date the plaintiff discovers or reasonably should have discovered""], 340.15, subd. (a)(2) [""[w]ithin three years from the date the plaintiff discovers or reasonably should have discovered""], 340.2, subd. (a)(2) [""[w]ithin one year after the date the plaintiff either knew, or through the exercise of reasonable diligence should have known""], 340.5 [""one year after the plaintiff discovers, or through the use of reasonable diligence should have discovered""].) This policy of charging plaintiffs with presumptive knowledge of the wrongful cause of an injury is consistent with our general policy encouraging plaintiffs to pursue their claims diligently. (Norgart, supra, 21 Cal.4th at p. 395, 87 Cal.Rptr.2d 453, 981 P.2d 79.)

Question 1

Is there any rationale for giving either propranolol, valproate or

buspirone to patients with cerebellar ataxia?

Question 2

Is there a laboratory marker for cerebral dominant arteriopathy with

subcortical infarcts and leucoencephalopathy (CADASIL)? Is serum lactic

acid elevated?

Question3

Primary brain tumours rarely metastasize outside the brain but

malignancies outside the brain frequently metastasize to the brain. Why?

Question 4

In a case of brain tumour, can papilloedema occur without a headache?

Question 5

What are the pathological diagnostic features of glioblastoma

multiforme?

Question 6

Is acetazolamide effective in cases of normal pressure hydrocephalus?

How effective is low-dose digoxin?

Question 7

If dementia and incontinence are present, but gait apraxia is not, can

normal pressure hydrocephalus be diagnosed?

Question 8

Is a normal CT (plain and with contrast) in patients with headache,

bilateral papilloedema and a clear conscious level sufficient to diagnose

benign intracranial hypertension?

Question 9

What is the value above which cerebrospinal fluid (CSF) pressure is said

to be raised?

Question 10

Could benign intracranial hypertension be diagnosed without headache

as a complaint?160"

Is there any reason to administer either of these drugs: propranolol, valproate, or buspirone to patients with cerebellar ataxia?

 Propranolol: May be of some use in reducing tremors which are a feature of the cerebellar ataxia but its use is restricted and not always successful.

 Valproate: Not given for cerebellar ataxia; more often given for epilepsy.

 Buspirone: Primarily employed in the management of anxiety disorders and its use in cereral ataxia is contraindicated.

 Is there a laboratory marker for cerebral dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)? Is serum lactic acid increased

 CADASIL: There are no special laboratory findings, however genetic test for mutations of the NOTCH3 gene is considered to be pathognomic for the disorder.

 Serum Lactic Acid: Usually, not increased in CADASIL.

 The primary brain tumour does not commonly spread to other parts of the body but the extra cranial tumors commonly spread to the brain. Why?

 Primary Brain Tumors: They tend to have a high propensity of invading local regions but they have low potential of spreading to distant sites because of the blood-brain barrier.

 Malignancies Outside the Brain: The brain is a preferred site for metastasis and is relatively privileged from lymphatic drainage, and therefore is frequently implicated in metastatic disease.

 It is very rare but possible for papilloedema to appear in a patient with a brain tumor without having a headache.

 Papilloedema does not always present with a headache, although headache is one of the most frequent symptoms. Other features of raised intracranial pressure may also be seen.

 What are the pathological hall marks of Glioblastoma multiforme?

 Diagnostic Features: Characterised by high cellularity, necrosis and vascular proliferation. Microscopic study shows that the tumour cells are pleomorphic and there are numerous mitotic figures.

 Can it then be said that acetazolamide is useful in normal pressure hydrocephalus? What can be said about the efficacy of low-dose digoxin?

 Acetazolamide: Usually not useful in the management of normal pressure hydrocephalus. It is more often employed for conditions that are associated with high intracranial pressure.

 Low-Dose Digoxin: Does not form part of the management of normal pressure hydrocephalus. Its use in this condition has not been well substantiated.

 Even if dementia and incontinence are demonstrated, but gait apraxia is not, is it possible to make a diagnosis of normal pressure hydrocephalus?

 Gait apraxia is not a feature of normal pressure hydrocephalus, so the patient does not have this condition. Diagnosis generally requires all three classic symptoms: Alzheimer’s disease, problem with walking, and inability to control urination.

 Are a normal CT (plain and with contrast) in patients with headache, bilateral papilloedema and a clear conscious level sufficient for the diagnosis of benign intracranial hypertension?

 BCS, also known as pseudotumor cerebri, often involves a high CSF pressure on lumbar puncture, and may not be apparent on CT scans alone.

 At what level is the cerebrospinal fluid pressure considered to be raised?

 Elevated CSF Pressure: Usually considered raised if it is more than 20-25 cm of water (or about 15-20 mmHg).

 Is benign intracranial hypertension possible to be diagnosed without headache as a chief complaint?

 No, headache is a frequent and one of the major manifestations of benign intracranial hypertension. A diagnosis is usually made in the course of a headache, papilloedema, or increased cerebrospinal fluid pressure.