Part I: The Patient Presents With 1
Preface 3
1.Disorders of Higher Cerebral Function 3
The frontal lobe 3
The parietal lobe 4
The temporal lobe 5
The occipital lobe 6
Summary 7
2.Disturbances of Consciousness 9
Transient loss of consciousnss 9
Coma 12
3.Headache 17
Differential diagnosis 17
history 18
Examination 19
Summary 20
4.Disorders of Smell 21
Differential diagnosis 21
Examination 22
Investigations 22
5.Visual lmpairment 23
The visual pathway 23
Clinical features of lesion localization 23
Differential diagnosis 25
Investigation of visual symptoms 26
6.Disorders of the Pupisl and Eye Movements 29
Pupil disorders 29
Differential diagnosis of pupil disorders 30
Disorders of eye movements 32
The trigeminal nerve 39
7.facial Sensory Loss and Weakness 39
Differential diagnosis of facial sensory loss 40
The facial nerve 41
Examination and differential diagnosis of facial weakness 42
Investigation of facial numbness and weakness 42
8.Deafness and Tinnitus 45
The auditory system 45
Differential diagnosis of deafness 46
Investigations 47
Differential diagnosis of tinnitus 47
The vestibular system 49
Differenfial diagnosis of dizziness and vertigo 49
9.Dizziness and Vertigo 49
Investigations 51
10.Dysarthria, Dysphonia, and Dysphagia 53
Definitions 53
Differential diagnosis of dysarthria 54
Differential diagnosis of dysphagia 55
Differential diagnosis of dysphonia 56
11.Cerebellar Dysfunction 57
The cerebellum 57
Clinical features of cerebellar dysfunction 58
Lesion Iolcalization 60
12.Tremor and Other Involuntary Movements 61
Tremor 61
Asterixis 62
Hemiballismus 63
Chorea and athetosis 63
Dystonia 63
Myoclonus 64
Habit spasms and tics 64
Akathisia 64
13.Limb Weakness 65
Terminology 65
Upper motor neuron weakness 65
Patterns of upper motor neuron weakness 66
Lower motor neuron weakness 68
Patterns of Iower motor neuron weakness 69
Disorders of the neuromuscular Iunction 70
Myopathy (disorders of the muscle) 70
Overview of conditions causing limb weakness 72
The dorsal (posterior)column pathway 73
14.Limb Sensory Symptoms 73
The spinothalamic pathway 74
Sensory syndromes 74
Summary 77
15.Disorders of Gait 79
Differential diagnosis 79
Part II: History, Examination, and Common Investigations 83
16.Taking a History 85
Things to remember when taking a history 85
Structure of the history 85
17.The Neurological Examination 87
Speech 87
Mental state and higher cerebral functios 88
The cranial nerves 91
Gait 91
The motor system 98
The sensory system 104
General examination 105
18.The Clerking 107
Sample neurology clerking 107
19.Further Investigations 111
Routine investigations 111
Neurophysiological inverstigations 114
Imaging of the nervous sytem 117
Part III: Background Information and Management Plans 119
Epidemiology 121
History and examination 121
General clinical features 121
Definition 121
20.Dementia 121
Investigations 122
Management 123
Primary degenerative dementia 123
Vascular dementia 124
Dementia as part of other degenerative diseases 124
Definitions 125
Classification 125
Epidemilology 125
Aetiology 125
Pathophysiology 126
Differential diagnosis 127
History and investigations to aid diagnosis 127
Clinical features 127
Drug treatment 128
Status enilenticus 129
Neurosurgical treatment of epilepsy 129
The social consequences of epilepsy 129
Driving and epilepsy 130
22.Headache and Craniofacial Pain 131
Tension headache 131
Migraine 131
Diagnosis and differential diagnosis 131
Management 132
Cluster headache 132
Giant-cell arteritis 132
Other neurological causes of headache and craniofacial pain 133
Non-neurological causes of headache and craniofacial pain 133
21.Epilepsy 133
Raised intracranial pressure 133
23.Parkinson s Disease, Other Extrapyramidal Disorders, and Myoclonus 135
Akinetic-rigid syndrome 135
Dyskinetic syndromes 138
Drug-induced movement disorders 140
Myoclonus 140
24.Common Cranial Neuropathies 141
Olfactory nerve (first cranial nerve) 141
Optic nerve (second cranial nerve) 141
Oculomotor, trochlear, and abducens nerves (third, fourth, and sixth cranial nerves) 141
Trigeminal nerve (fifth cranial nerve) 144
Facial nerve (seventh cranial nerve) 144
Vestibulocochlear nerve (eighth cranial nerve) 145
The lower cranial nerves-glossopharyngeal (ninth), Vagus (tenth), accessory (eleventh), and hypoglossal (twelfth) 146
25.Diseases Affecting the Spinal Cord (Myelopathy) 147
Anatomy of the spinal cord 147
Maiot pathways in the spinal cord 147
Causes of spinal cord disease 148
26.Motor Neuron Disease 153
Anatomy of the motor system 153
Types of motor neuron disease(MND) 153
Epidemiology 154
Differential diagnosis 154
Diagnosis 155
Treatment 155
Radiculopathy (nerve root lesions) 157
Anatomy 157
27.Radiculopathy and Plexopathy 157
Plexopathies (lesions of the brachial or Iumbosacral plexus) 158
28.Disorders of Peripheral Nerve 161
Anatomy 161
Nerve fibre type 161
Pathological processes 161
Definitions of neuropathies 162
Symptoms of peripheral nerve disease 162
Signs of peripheral neuropathy 163
Investigation of peripheral neuropathy 163
Specific neuropathies 163
Neuropathies associated with systemic disease 166
Summary 167
Neuropathies caused by toxins 167
Neuropathies caused by nutritional deficiencies 167
29.Disorders of Neuromuscular Transmission 169
Normal anatomy and physiology 169
Myasthenia gravis 169
Lambert-Eaton myasthenic syndrome 171
Other myasthenic syndromes 171
Botulinum toxin 171
30.Disorders of Skeletal Muscle 173
Anatomy 173
Clinical features of muscle disease 173
Family history 174
Investigation of muscle disease 174
Specific muscle diseases 174
Cerebrovascular disease 179
31.Vascular Diseases of the Nervous System 179
Intracranial haemorrhage 184
Cerebrovascular involvement in vasculitis and connective tissue diseases 186
Cerebral venous thrombosis 186
Spinal cord vascular disease 186
32.Intracranial Tumours 189
Types of intracranial tumour 189
Clinical features of intracranial tumours 190
Investigation 191
Treatment 193
Prognosis 193
33.Infections of the Nervous System 195
General conditions 195
Specific organisms and the neurological diseases they cause 199
34.Multiple Sclerosis 205
Incidence 205
Pathogenesis 205
Pathology 205
Clinical features 206
Differential diagnosis 207
Management 207
Other central demyelinating diseases 208
35.Systemic Disease and the Nervous System 209
Neurological complications of endocrine disease 209
Neurological complications of renal disease 209
Neurological complications of connective tissue disease 210
Neurological complications associated with cardiac disease 211
Neurological complications of neoplastic disease 211
36.Effects of Deficiency Diseases and Toxins on the Nervous System 213
Deficiency diseases 213
Toxins 214
37.Hereditary Conditions of the Nervous System 215
Non-metabolic hereditary conditions 215
Inborn errors of metabolism 217
Part IV: Self-assessment 219
Multiple-choice Questions 221
Short-answer Questions 225
Patient Management Problems 226
MCQ Anesers 228
SAQ Answers 229
PMP Answers 232
Index 235