492 Crash Course Neurology 4e Dr Zaheer

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Front Cover
	Crash Course: Neurology
	Copyright
	Series editor foreword
	Preface
	Acknowledgements
	Dedication
	Contents
	PART I: HISTORY, EXAMINATION AND COMMON INVESTIGATIONS
	Chapter 1: Taking a history
	STRUCTURE OF THE HISTORY
	The presenting complaint
	History of the presenting complaint
	Past medical history
	Drug history
	Review of systems
	Family history
	Social history
	Summary
	Chapter 2: The neurological examination
	MENTAL STATE AND HIGHER CEREBRAL FUNCTIONS
	Consciousness
	Appearance and behaviour
	Affect
	Cognitive function
	Mini-mental State Examination
	SPEECH
	Phonation: dysphonia
	Assessment
	Articulation: dysarthria
	Assessment
	Language production: dysphasia
	Assessment
	GAIT
	CRANIAL NERVES
	Olfactory nerve (first, I)
	Optic nerve (second, II)
	Visual acuity
	Colour vision
	Visual fields
	Peripheral fields
	Blind spot
	Central field
	Perimetry
	Fundoscopy
	Oculomotor (third, III), trochlear (fourth, IV), and abducens (sixth, VI) nerves
	Eyelids
	Pupils
	Size and shape
	Light response
	Accommodation
	Eye movements
	Pursuit eye movements
	Saccadic eye movements
	Ocular nerve palsies
	Nystagmus
	Trigeminal (fifth, V) nerve
	Motor
	Jaw jerk
	Sensory
	Facial (seventh, VII) nerve
	Motor
	Sensory
	Taste (visceral afferent)
	Vestibulocochlear nerve (eighth, VIII)
	Hearing
	Vestibular function
	Glossopharyngeal (ninth, IX) and vagus (tenth, X) nerves
	Motor
	Sensory
	Accessory (eleventh, XI) nerve
	Hypoglossal (twelfth, XII) nerve
	THE MOTOR SYSTEM
	Inspection
	Tone
	Arm
	Pyramidal hypertonia: spasticity
	Extrapyramidal rigidity
	Legs
	Power
	Reflexes
	Coordination
	Gait
	Arms
	Legs
	The heel–shin test
	The tapping test
	THE SENSORY SYSTEM
	Sensory testing
	Sensory modalities
	Pain
	Temperature
	Light touch
	Joint-position sense
	Vibration
	Two-point discrimination
	GENERAL EXAMINATION
	Chapter 3: Further investigations
	ROUTINE INVESTIGATIONS
	NEUROPHYSIOLOGICAL INVESTIGATIONS
	Electroencephalography
	Electromyography and nerve conduction studies
	EMG
	Nerve conduction studies
	Evoked potentials
	IMAGING OF THE NERVOUS SYSTEM
	Plain radiography
	Skull radiography
	Spinal radiography
	Computed tomography scanning
	Magnetic resonance imaging
	Myelography
	Catheter arteriography
	Duplex ultrasonography
	PART II: THE PATIENT PRESENTS WITH...
	Chapter 4: Disorders of higher cerebral function
	FRONTAL LOBE
	Normal functions
	Blood supply
	Symptoms from lesions of the frontal lobe
	PARIETAL LOBE
	Function
	Blood supply
	Symptoms from lesions of the parietal lobe
	Syndromes of the dominant parietal lobe
	Syndromes of the non-dominant parietal lobe
	TEMPORAL LOBE
	Function
	Blood supply
	Symptoms from lesions of the temporal lobe
	DYSPHASIA
	OCCIPITAL LOBE
	Function
	Blood supply
	Symptoms from lesions of the occipital lobe
	Chapter 5: Disturbances of consciousness
	TRANSIENT LOSS OF CONSCIOUSNESS
	Syncope
	1. Vasovagal syncope
	2. Situational syncope – micturition and cough syncope
	3. Postural hypotension
	4. Syncope due to primary cardiac dysfunction
	5. Carotid sinus disease
	Seizures
	Hypoglycaemia
	Narcolepsy/cataplexy
	Hyperventilation
	Vertebrobasilar ischaemia
	Non-epileptic attacks
	Investigating transient loss of consciousness
	DRIVING AND EPISODES OF DISTURBANCES OF CONSCIOUSNESS
	COMA
	Differential diagnosis of coma
	Non-convulsive status epilepticus
	Akinetic mutism
	Locked-in syndrome
	Persistent vegetative state
	Catatonia
	Causes of persistent disturbance of consciousness
	Clinical approach to the comatose patient
	Examination of the comatose patient
	Signs of head injury
	Neck stiffness
	Respiratory pattern
	Pupil responses
	Resting position of the eyes
	Ocular movements
	Fundoscopic abnormalities
	Corneal reflexes
	Limb posture and movement
	Investigations in the comatose patient
	Prognosis of coma
	BRAINSTEM DEATH
	Chapter 6: Headache
	Recurrent episodic headache
	Chronic daily headache
	New daily persistent headache
	Subacute-onset and progressive headache
	Acute-onset headache
	HISTORY
	EXAMINATION
	Chapter 7: Disorders of smell and taste
	DIFFERENTIAL DIAGNOSIS
	Anosmia and hyposmia
	Ageusia and dysgeusia
	Hyperosmia
	Olfactory hallucinations
	Examination
	INVESTIGATIONS
	Chapter 8: Visual impairment
	THE ANATOMICAL PATH OF LIGHT STIMULATION
	1. Retina to optic nerve
	2. Optic nerve to optic chiasm
	3. Optic chiasm to lateral geniculate nucleus
	4. Lateral geniculate nucleus to occipital cortex
	BLOOD SUPPLY TO THE VISUAL PATHWAY
	Visual field defects
	CLINICAL FEATURES TO AID LOCALIZATION OF A LESION
	Retinal lesion
	Optic nerve lesion (see 1, Fig. 8.1)
	Optic chiasm lesion (see 2, Fig. 8.1)
	Optic radiation and optic tract lesions (see 3, 4, 5, Fig. 8.1)
	Occipital cortex lesions (see 6, Fig. 8.1)
	DIFFERENTIAL DIAGNOSIS OF VISUAL LOSS
	Monocular or binocular visual impairment
	Acute transient visual impairment
	Amaurosis fugax
	Migraine with aura
	Papilloedema
	Acute persistent visual impairment
	Optic neuritis
	Retinal or optic nerve ischaemia
	Arterial thromboembolism of the middle or posterior cerebral artery
	OPTIC ATROPHY
	Chapter 9: Disorders of the pupils and eye movements
	PUPILLARY REFLEXES
	Pupillary light reflex pathway – parasympathetic pathways
	Pupillary light reflex pathway – sympathetic pathways
	The accommodation reflex
	DIFFERENTIAL DIAGNOSIS OF PUPIL DISORDERS
	Anisocoria
	Physiological anisocoria
	Small constricted (miotic) pupil
	Old age
	Medications
	Horner syndrome
	Argyll Robertson pupils
	Large dilated (mydriatic) pupil
	Disorders of the iris and iatrogenic mydriasis
	Third nerve lesions
	Holmes–Adie pupil
	Relative afferent pupillary defect
	DISORDERS OF EYE MOVEMENTS
	Conjugate gaze
	Binocular diplopia
	Dysfunction of the extraocular muscles
	Dysfunction at the neuromuscular junction
	Dysfunction of the ocular cranial nerves
	Lesions of the third (oculomotor) nucleus and nerve (see Figs 9.6 and 9.7)
	Lesions of the fourth (trochlear) nucleus and nerve (see Figs 9.8 and 9.9)
	Lesions of the sixth (abducens) nucleus and nerve (see Figs 9.10 and 9.11)
	Lesions of the brainstem and the internuclear pathways
	Supranuclear lesions
	Horizontal gaze palsy
	One-and-a-half syndrome
	Vertical gaze palsy
	Nystagmus
	Pendular nystagmus due to visual impairment
	Congenital nystagmus
	Jerky nystagmus
	Physiological nystagmus
	‘Nystagmoid jerks’
	Optokinetic nystagmus
	Pathological nystagmus
	Central nystagmus
	Peripheral nystagmus
	Chapter 10: Facial sensory loss and weakness
	THE TRIGEMINAL NERVE
	DIFFERENTIAL DIAGNOSIS OF FACIAL SENSORY LOSS
	Supranuclear lesions
	Brainstem lesions
	Cerebellopontine angle lesions
	Cavernous sinus lesions
	Lesions of the trigeminal root, ganglion and peripheral branches of the nerve
	FACIAL NERVE
	Facial nerve anatomy
	Upper and lower motor neuron facial weakness
	Differential diagnosis of facial weakness
	Chapter 11: Deafness, tinnitus, dizziness and vertigo
	DEAFNESS AND TINNITUS
	THE AUDITORY SYSTEM
	DIFFERENTIAL DIAGNOSIS OF DEAFNESS
	Rinne's test
	Weber's test
	Conductive deafness
	Sensorineural deafness
	Disorders of the cochlear apparatus
	Disorders of the cochlear nerve
	Disorders of the brainstem
	Disorders of the supranuclear connections
	Investigations for deafness
	DIFFERENTIAL DIAGNOSIS OF TINNITUS
	THE VESTIBULAR SYSTEM
	DIFFERENTIAL DIAGNOSIS OF DIZZINESS AND VERTIGO
	Clinical features of labyrinthine failure
	Examples of labyrinthine failure
	Ménière's disease
	Benign paroxysmal positional vertigo
	Other causes
	Vestibular nerve lesions
	Vestibular neuronitis
	Cerebellopontine angle lesions
	Brainstem lesions
	Cerebellar lesions
	Other types of dizziness
	INVESTIGATIONS
FOR VERTIGO
	Hallpike manoeuvre
	Caloric test
	Chapter 12: Dysarthria, dysphonia and dysphagia
	DEFINITIONS
	DYSARTHRIA
	Upper motor neuron lesions
	Lower motor neuron lesions
	Basal ganglia lesions
	Parkinson's disease
	Chorea
	Athetosis
	Cerebellar lesions
	Myopathies and disorders of the neuromuscular junction
	Oropharyngeal lesions
	DYSPHAGIA
	Sites of lesions causing dysphagia
	DYSPHONIA
	Chapter 13: Cerebellar dysfunction
	CLINICAL FEATURES OF CEREBELLAR DYSFUNCTION
	Incoordination of movement
	Ataxic gait
	Ataxic dysarthric speech
	Abnormal eye movements
	Titubation
	Altered posture
	Hypotonia
	LOCALIZATION OF A CEREBELLAR LESION
	Cerebellar hemisphere
	Cerebellar vermis
	Chapter 14: Movement disorders
	THE ANATOMICAL BASIS AND CLASSIFICATION OF MOVEMENT DISORDERS
	THE HYPERKINETIC MOVEMENT DISORDERS: TREMOR AND DYSTONIA
	Tremor
	Resting tremor
	Postural tremor
	1. Physiological tremor
	2. Essential tremor
	3. Neuropathic tremor
	4. Dystonic tremor
	Kinetic tremor
	1. Cerebellar tremor (intention tremor)
	2. Red nuclear ‘rubral’ tremor
	Mixed tremors
	DYSTONIA
	1. Primary dystonia
	2. Dystonia-plus syndromes – dopa-responsive dystonia
	3. Secondary dystonia
	4. Paroxysmal dystonia
	THE HYPERKINETIC MOVEMENT DISORDERS: CHOREA, TICS AND MYOCLONUS
	Chorea
	Huntington's disease (Huntington's chorea)
	Ballism
	Tics
	Myoclonus
	1. Myoclonic epilepsy
	2. Progressive myoclonic epilepsy
	3. Symptomatic myoclonus
	Chapter 15: Limb weakness
	NEUROANATOMY
	The upper motor neuron pathway
	The lower motor neuron pathway
	The neuromuscular junction and muscle pathway
	TERMINOLOGY
	UPPER MOTOR NEURON WEAKNESS
	Increased tone (spasticity)
	‘Pyramidal-pattern’ weakness
	Absence of muscle wasting and fasciculations
	Brisk tendon reflexes and extensor plantar responses
	UPPER MOTOR NEURON SYNDROMES
	Hemiparesis – unilateral arm and leg weakness
	Tetraparesis – weakness in all four limbs
	Paraparesis – weakness in both legs
	Monoparesis – weakness of a single limb
	LOWER MOTOR NEURON WEAKNESS
	Decreased tone
	Focal pattern of weakness and wasting
	Fasciculations
	Pain and sensory disturbance
	Reduced tendon reflexes and flexor plantar responses
	LOWER MOTOR NEURON SYNDROMES
	Anterior horn cell disease
	Radiculopathy and plexopathy
	Brachial plexopathy
	Lumbosacral plexopathy
	Neuropathy
	DISORDERS OF THE NEUROMUSCULAR JUNCTION
	MYOPATHY
	Chapter 16: Limb sensory symptoms
	DORSAL (POSTERIOR) COLUMN PATHWAY
	SPINOTHALAMIC PATHWAY
	TROPHIC SKIN CHANGES AND ULCERS
	SENSORY SYNDROMES
	Lesions of peripheral nerves
	Mononeuropathy
	Multiple mononeuropathy
	Polyneuropathy
	Lesions of the spinal nerve roots, dorsal roots and ganglia
	Lesions of the spinal cord
	Transection of the cord
	Lesion of the posterior spinal cord
	Lesion of the anterior cord
	Hemisection of the cord (Brown–Séquard syndrome)
	Central cord lesion
	Lesions of the brainstem
	Lesions of the thalamus
	Lesions of the parietal lobe
	Chapter 17: Disorders of gait
	PRACTICAL APPROACH TO THE ASSESSMENT OF GAIT
	DIFFERENTIAL DIAGNOSIS OF DISORDERS OF GAIT
	Gait of cerebellar ataxia
	Hemiparetic gait
	Spastic gait
	Parkinsonian gait
	Gait of sensory ataxia
	Steppage gait
	Myopathic gait
	Apraxic gait
	Antalgic gait
	Functional gait
	PART III: DISEASES AND DISORDERS
	Chapter 18: Dementia
	DEFINITION
	DIFFERENTIAL DIAGNOSES
	EPIDEMIOLOGY
	GENERAL CLINICAL FEATURES
	HISTORY
	EXAMINATION
	INVESTIGATIONS
	Blood tests
	Imaging of the brain
	Lumbar puncture
	Neuropsychometry
	Electroencephalography
	Genetic testing
	Brain biopsy
	MANAGEMENT
	PRIMARY NEURODEGENERATIVE DEMENTIAS
	Alzheimer's disease
	Pathology
	Clinical features
	Diagnosis
	Drug treatment
	Prognosis
	Dementia with Lewy bodies
	Frontotemporal lobar dementia
	Vascular dementia
	Diagnosis
	Treatment
	VASCULITIS
	DEMENTIA AS A PART OF OTHER DEGENERATIVE DISEASES
	PSEUDODEMENTIA
	Chapter 19: Epilepsy
	DEFINITIONS
	CLASSIFICATION OF SEIZURES
	EPIDEMIOLOGY
	AETIOLOGY
	Family history
	Antenatal and perinatal factors
	Trauma and surgery
	Metabolic causes
	Toxic causes
	Infectious and inflammatory causes
	Vascular causes
	Intracranial tumours
	Hypoxia
	Degenerative diseases
	Photosensitivity
	Sleep deprivation
	CLINICAL FEATURES
	Partial seizures
	Simple partial seizures
	Complex partial seizures
	Secondarily generalized seizures
	Generalized seizures
	Generalized tonic–clonic seizures
	Absence seizures
	Myoclonic seizures
	Atonic and tonic seizures
	HISTORY AND INVESTIGATIONS TO AID DIAGNOSIS
	DIFFERENTIAL DIAGNOSES
	DRUG TREATMENT
	When to start drug treatment
	What drugs to choose
	Pharmacokinetics of antiepileptic drugs
	Adverse effects of antiepileptic drugs
	Acute toxicity
	Idiosyncratic toxicity
	Chronic toxicity
	Teratogenicity and pregnancy
	Withdrawal of antiepileptic drugs
	STATUS EPILEPTICUS
	Drug treatment
	NEUROSURGICAL TREATMENT OF EPILEPSY
	MORTALITY OF EPILEPSY
	DRIVING AND EPILEPSY
	Chapter 20: Headache and craniofacial pains
	TENSION-TYPE HEADACHE
	MIGRAINE
	Migraine with aura or ‘classical migraine’
	Common migraine
	Basilar migraine
	Hemiplegic migraine
	Management
	During an attack
	Prophylaxis
	CLUSTER HEADACHE
	Treatment
	OTHER NEUROLOGICAL CAUSES OF HEADACHE AND CRANIOFACIAL PAIN
	Headache of raised intracranial pressure
	Low pressure headache
	NON-NEUROLOGICAL CAUSES OF HEADACHE AND CRANIOFACIAL PAIN
	Giant-cell arteritis (temporal arteritis)
	Diagnosis
	Treatment
	Local causes
	Chapter 21: Parkinson's disease and other extrapyramidal disorders
	AKINETIC–RIGID SYNDROMES
	Parkinson's disease
	Pathology
	Aetiology
	Clinical features
	Tremor
	Rigidity
	Bradykinesia, hypokinesia and akinesia
	Postural changes
	Non-motor, cognitive and psychiatric features
	Natural history
	Investigations
	Treatment
	Levodopa (L-dopa)
	Dopamine agonists
	Anticholinergic drugs
	Monoamine oxidase B inhibitors
	COMT (catechol-O-methyltransferase) inhibitors
	Management of hallucinations, psychosis and confusion
	Surgery
	Differential diagnosis of Parkinson’s disease
	The atypical parkinsonian disorders
	Progressive supranuclear palsy
	Multisystem atrophy
	Corticobasal degeneration
	Other parkinsonian syndromes
	Medication-induced parkinsonism
	Cerebrovascular disease
	Wilson’s disease
	NEUROLEPTIC-INDUCED MOVEMENT DISORDERS
	Acute dystonic reactions
	Medication-induced parkinsonism
	Akathisia
	Tardive dyskinesia
	Neuroleptic malignant syndrome
	RESTLESS LEGS SYNDROME
	Chapter 22: Cranial nerve lesions
	OLFACTORY NERVE (FIRST, I)
	OPTIC NERVE (SECOND, II)
	Visual field defects
	Papilloedema
	Optic neuritis
	Optic atrophy
	OCULOMOTOR (THIRD, III), TROCHLEAR (FOURTH, IV) AND ABDUCENS NERVES (SIXTH, VI)
	Combined ocular palsies
	TRIGEMINAL NERVE (FIFTH, V)
	Trigeminal neuralgia (‘tic douloureux’)
	Postherpetic neuralgia
	FACIAL NERVE (SEVENTH, VII)
	Bell's palsy
	VESTIBULOCOCHLEAR NERVE (EIGHTH, VIII)
	Cerebellopontine angle lesions
	Ménière's disease
	Benign paroxysmal positional vertigo
	Acute vestibular failure
	LOWER CRANIAL NERVES (GLOSSOPHARYNGEAL, VAGUS, ACCESSORY AND HYPOGLOSSAL)
	Jugular foramen syndrome
	Chapter 23: Diseases affecting the spinal cord (myelopathy)
	ANATOMY
	MAJOR PATHWAYS WITHIN THE SPINAL CORD
	Pain and temperature
	Proprioception (joint-position sense) and vibration
	Motor pathways
	The clinical syndromes of spinal cord disease
	Paraparesis (spastic paraparesis or paraplegia)
	Tetraparesis (spastic tetraparesis, tetraplegia, quadriparesis and quadriplegia)
	Brown–Séquard syndrome (unilateral cord lesion)
	CAUSES OF SPINAL CORD DISEASE
	Transection of the cord
	Differential diagnosis
	Treatment
	Spinal cord compression
	Causes
	Degenerative disease – spondylotic/disc disease
and spinal canal stenosis
	Spinal cord tumours
	Infective lesions
	Epidural haemorrhage and haematoma
	Vascular cord lesions
	Anterior spinal artery occlusion
	Dural ateriovenous fistulas
	Intramedullary spinal arteriovenous malformations
	Cavernous haemangiomas
	Transverse myelitis
	Metabolic and toxic cord disease
	Subacute combined degeneration of the cord
	Copper deficiency myeloneuropathy
	Intrinsic cord lesions
	Syringomyelia and syringobulbia
	Chapter 24: Motor neuron disease
	TYPES AND CLINICAL FEATURES OF MOTOR NEURON DISEASE
	Amyotrophic lateral sclerosis
	Progressive muscular atrophy
	Progressive bulbar and pseudobulbar palsy
	Primary lateral sclerosis
	PATHOGENESIS
	DIFFERENTIAL DIAGNOSIS
	Amyotrophic lateral sclerosis
	Progressive muscular atrophy
	Pseudobulbar/bulbar palsy
	DIAGNOSIS
	TREATMENT
	Drug treatment
	Symptomatic treatment
	Chapter 25: Radiculopathy and plexopathy
	ANATOMY
	RADICULOPATHY (SPINAL NERVE ROOT LESIONS)
	Clinical features
	Specific radiculopathies
	Lateral cervical disc protrusion
	Lateral lumbar disc protrusion
	Central lumbar disc protrusion
	PLEXOPATHIES
	Brachial plexopathies
	Trauma
	Neuralgic amyotrophy (acute brachial neuropathy, brachial neuritis)
	Malignant infiltration
	Pancoast tumour
	Radiotherapy-induced plexopathy
	Compression
	Cervical rib (thoracic outlet syndrome)
	Lumbosacral plexus
	Diabetic amyotrophy
	Chapter 26: Disorders of the peripheral nerves
	ANATOMY
	DEFINITIONS OF NEUROPATHIES
	SYMPTOMS OF NEUROPATHY
	Sensory symptoms and signs
	Negative symptoms (loss of sensation)
	Positive symptoms
	Sensory examination
	Autonomic symptoms
	Motor symptoms
	Motor examination
	Skeletal symptoms
	INVESTIGATION OF PERIPHERAL NEUROPATHY
	SPECIFIC NEUROPATHIES
	Mononeuropathies
	Peripheral nerve compression and entrapment neuropathies
	Carpal tunnel syndrome
	Ulnar nerve compression
	Radial nerve compression
	Common peroneal nerve palsy
	Lateral cutaneous nerve of the thigh (meralgia paraesthetica)
	Multifocal neuropathy (mononeuritis multiplex)
	Polyneuropathies
	Polyneuropathies associated with systemic disease
	Diabetic neuropathy
	Renal disease
	Paraneoplastic polyneuropathy
	Connective tissue diseases and vasculitides
	Porphyria
	Amyloidosis
	Neuropathies caused by drugs and toxins
	Drugs
	Toxins
	Alcoholic neuropathy
	Inflammatory demyelinating neuropathies
	Guillain–Barré syndrome (postinfective polyneuropathy)
	Chronic inflammatory demyelinating polyradiculoneuropathy
	Multifocal motor neuropathy
	Neuropathies caused by nutritional deficiencies
	Thiamine (vitamin B1) deficiency (beriberi)
	Pyridoxine (vitamin B6) deficiency
	Vitamin B12 deficiency
	Vitamin E deficiency
	Neuropathies caused by infection
	Hereditary neuropathies
	General characteristics of hereditary motor sensory neuropathies
	Critical illness polyneuropathy
	Chapter 27: Disorders of the neuromuscular junction
	MYASTHENIA GRAVIS
	Clinical features
	Investigations
	Tensilon (edrophonium) test
	Serum acetylcholine receptor and MUSK antibodies
	Electromyography
	Thymus imaging
	Autoantibodies
	Spirometry
	Management
	Oral acetylcholinesterases
	Thymectomy
	Immunosuppression
	LAMBERT–EATON MYASTHENIC SYNDROME
	OTHER MYASTHENIC SYNDROMES
	BOTULINUM TOXIN
	Chapter 28: Disorders of skeletal muscle
	ANATOMY
	CLINICAL FEATURES OF MUSCLE DISEASE (MYOPATHY)
	Weakness
	Changes in muscle tone
	Changes in muscle bulk
	Changes in reflexes
	Changes in muscle contractility
	Pain
	Onset of muscle weakness and family history
	INVESTIGATION OF MUSCLE DISEASE
	SPECIFIC DISEASES
	Hereditary myopathies
	Muscular dystrophies
	Duchenne muscular dystrophy
	Becker’s muscular dystrophy
	Other muscular dystrophies
	Myotonic disorders
	Myotonic dystrophy (dystrophia myotonica)
	Metabolic myopathies
	Periodic paralyses
	Hypokalaemic periodic paralysis
	Hyperkalaemic periodic paralysis
	Mitochondrial myopathies
	Inflammatory myopathies
	Polymyositis and dermatomyositis
	Clinical features
	Investigations
	Treatment
	Inclusion body myositis
	Acquired electrolyte and endocrine myopathies
	Thyrotoxicosis
	Cushing’s syndrome
	Hypokalaemia
	Vitamin D deficiency
	Drug-induced myopathies
	Paraneoplastic myopathy
	Critical Illness myopathy
	Chapter 29: Vascular diseases of the nervous system
	CEREBROVASCULAR DISEASE
	Definitions
	Stroke
	Transient ischaemic attack
	Types of stroke
	Incidence of stroke
	Aetiology of stroke
	Risk factors
	Vascular anatomy
	Clinical syndromes
	Transient ischaemic attacks
	Middle cerebral artery occlusion
	Anterior cerebral artery occlusion
	Posterior cerebral artery occlusion
	Carotid artery occlusion
	Lacunar stroke
	Vertebral and basilar artery occlusion – brainstem stroke
	Specific brainstem syndromes
	Border zone ischaemia
	Primary intracerebral haemorrhage
	Investigation of stroke and transient ischaemic attack
	Initial investigations
	Special investigations
	Imaging
	Carotid Doppler
	Cerebral angiography
	Echocardiography and Holter monitoring
	Management of stroke
	Thrombolysis
	Other management aims
	Management of transient ischaemic attacks
	Prognosis
	INTRACRANIAL HAEMORRHAGE
	Subarachnoid haemorrhage
	Causes
	Risk factors
	Clinical features
	Investigation
	Immediate management
	Subsequent management
	Prognosis
	Subdural and extradural haemorrhage
	Subdural haematoma
	Extradural haemorrhage
	Management
	CEREBROVASCULAR INVOLVEMENT IN VASCULITIS
	Investigations
	Treatment
	CEREBRAL VENOUS THROMBOSIS
	Clinical features
	Cavernous sinus thrombosis
	Diagnosis
	Treatment
	DISSECTION
	VASCULAR DISEASE OF THE SPINAL CORD
	Anterior spinal artery syndrome
	Causes
	Clinical features
	Management
	Chapter 30: Neuro-oncology
	TYPES OF INTRACRANIAL TUMOUR
	Gliomas
	Astrocytoma
	Oligodendroglioma
	Glioblastoma multiforme
	Ependymoma
	Meningiomas
	Primary central nervous system lymphoma
	Pituitary tumours
	Nerve sheath tumours – neurofibromas and schwannomas
	Haemangioblastomas
	Metastases
	CLINICAL FEATURES OF INTRACRANIAL TUMOURS
	Raised intracranial pressure
	Herniation
	False localizing signs
	Focal neurological signs
	Seizures
	INVESTIGATIONS
	Computed tomography
	Magnetic resonance imaging
	Specialized neuroradiology
	Stereotactic brain biopsy
	TREATMENT
	Cerebral oedema and raised intracranial pressure
	Seizures
	Surgery
	Radiotherapy and chemotherapy
	PROGNOSIS
	NEUROLOGICAL COMPLICATIONS OF CANCER
	Chapter 31: Infections of the nervous system
	GENERAL CONDITIONS
	Meningitis
	Causative agents
	Bacteria
	Clinical features
	Viral meningitis
	Tuberculous meningitis
	Fungal meningitis
	Diagnosis
	Staining of cerebrospinal fluid
	Cerebrospinal fluid culture
	Other required tests
	Polymerase chain reaction
	Serology
	Imaging
	Complications
	Treatment
	The role of adjunctive dexamethasone in adults with bacterial meningitis
	Tuberculous meningitis
	Viral meningitis
	Infection control, notification and chemoprophylaxis of contacts
	Encephalitis
	Definition
	Aetiology
	Infectious causes of encephalitis
	Clinical features
	Diagnosis
	Treatment
	Prognosis
	Cerebral abscess
	Definition
	Aetiology
	Causative organisms
	Clinical features
	Diagnosis
	Treatment
	Prognosis
	SPECIFIC ORGANISMS AND THEIR ASSOCIATED DISEASES
	Tuberculosis
	Diagnosis
	Neurological complications of tuberculosis
	Tuberculoma
	Spinal tuberculosis (Pott’s disease)
	Spinal arachnoiditis
	Treatment
	Syphilis
	Conditions associated with neurosyphilis
	Asymptomatic neurosyphilis (early/late)
	Meningovascular (2–7 years)
	Tabes dorsalis (15–20 years)
	General paralysis of the insane (10–20 years)
	Diagnosis
	Serological testing
	Evaluation of neurological syphilis
	Treatment
	Human
immunodeficiency virus
	Central nervous system involvement
	Central nervous system lesions with mass effect
	CNS lesions without mass effect
	Dementia in HIV-infected patients
	Peripheral nervous system involvement
	Peripheral neuropathy
	Myopathy
	Poliomyelitis
	Clinical features
	Diagnosis of paralytic poliomyelitis
	Treatment of paralytic poliomyelitis
	Prognosis
	Vaccination
	Post-polio syndrome
	Lyme disease
	Clinical features
	Diagnosis
	Treatment
	Prognosis
	Prion diseases
	Creutzfeldt–Jakob disease
	Sporadic Creutzfeldt–Jakob disease
	Variant Creutzfeldt–Jakob disease
	Iatrogenic Creutzfeldt–Jakob disease
	Diagnosis
	Treatment
	Chapter 32: Multiple sclerosis
	EPIDEMIOLOGY
	PATHOGENESIS
	PATHOLOGY
	CLINICAL FEATURES
	Optic and retrobulbar neuritis
	Brainstem/cerebellar presentation
	Spinal cord lesion (myelopathy)
	Other symptoms
	DIFFERENTIAL DIAGNOSIS
	INVESTIGATIONS
	Magnetic resonance imaging
	Cerebrospinal fluid examination
	Evoked potentials
	Visual evoked potentials
	Somatosensory evoked potentials
	Brainstem auditory evoked potentials
	DIAGNOSIS
	MANAGEMENT
	Treatments for acute relapses
	Corticosteroid therapy
	Disease-modifying treatment
	Beta-interferon and glatiramer acetate
	Other immunomodulatory agents
	Symptomatic treatment
	OTHER CENTRAL DEMYELINATING DISEASES
	Chapter 33: Systemic disease and the nervous system
	ENDOCRINE DISORDERS
	Diabetes mellitus
	Hypoglycaemia and hyperglycaemia
	Cerebrovascular disease
	Visual loss
	Peripheral nerve lesions
	Hyperthyroidism
	Hypothyroidism
	Pituitary gland
	Electrolyte imbalances
	HAEMATOLOGICAL DISORDERS
	Anaemias
	Proliferative conditions
	Clotting disorders
	GASTROINTESTINAL DISORDERS
	RENAL DISORDERS
	VASCULITIDES AND CONNECTIVE TISSUE DISORDERS
	CARDIAC DISORDERS
	OTHER MULTISYSTEM DISEASES
	Sarcoidosis
	Behçet's disease
	Chapter 34: The effects of vitamin deficiencies and toxins on the nervous system
	VITAMIN DEFICIENCIES
	Vitamin B1 (thiamine) deficiency
	Beriberi
	Wernicke–Korsakoff syndrome
	Vitamin B6 (pyridoxine) deficiency
	Vitamin B12 deficiency
	Vitamin B3 (nicotinic acid) deficiency
	Vitamin D deficiency
	Vitamin E deficiency
	TOXINS
	Chapter 35: Hereditary conditions affecting the nervous system
	THE NEUROCUTANEOUS SYNDROMES
	Neurofibromatosis
	Neurofibromatosis type 1 (von Recklinghausen’s disease)
	Neurofibromatosis type 2
	Treatment
	Tuberous sclerosis
	Treatment
	Sturge–Weber syndrome
	HEREDITARY ATAXIAS
	Friedreich’s ataxia
	Ataxia telangiectasia
	Spinocerebellar ataxias
	INHERITED NEUROPATHIES
	INBORN ERRORS OF METABOLISM
	Acute intermittent porphyria
	Wilson’s disease (hepatolenticular degeneration)
	SELF-ASSESSMENT
	Single best answer questions (SBAs)
	Extended-matching questions (EMQs)
	SBA answers
	EMQ answers
	Objective structured clinical examination (OSCE) stations 
	1. This 33 year old lady has developed clumsiness and has difficulty walking. Please conduct a physical examination of he...
	Checklist
	2. This 48 year old man has had progressive difficulty in walking over the last 2 months. He has also experienced some ur...
	Checklist
	3. This 60-year-old man is complaining of numbness and pins and needles in his feet. Examine the sensory system in his le...
	Checklist
	4. Please examine the 3rd, 4th, 5th, 6th and 7th cranial nerves of this patient. Describe to the examiner what you are do...
	Checklist
	5. Paul, who is a 36-year-old gentleman, needs to have an elective lumbar puncture. Can you explain the procedure to him?
	Checklist
	After the procedure
	Risks
	6. This 22-year-old lady presents with headaches. Please take a focused headache history
	Checklist
	Glossary
	Index