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Functional Neurologic Disorder (FND)
https://www.ncbi.nlm.nih.gov/books/NBK551567 Definition: Functional neurologic disorder (FND), formerly known as conversion disorder, involves sensory or motor symptoms that are inconsistent with recognized neurological diseases or medical conditions and significantly impair patient functioning. Symptoms are involuntary and not intentionally produced. Etiology: Epidemiology: Aetiology Differential Diagnosis: Psychiatric Disorders: Neurological Disorders: Symptoms Sensorimotor Symptoms:…
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Pseudobulbar palsy and Balbar palsy
Aspect Pseudobulbar Palsy Bulbar Palsy Definition A condition due to bilateral upper motor neuron lesions affecting the corticobulbar tracts. A condition due to lower motor neuron lesions affecting the cranial nerves IX, X, XI, and XII. Causes Stroke, multiple sclerosis, motor neuron disease, head trauma, brain tumors, and cerebral palsy.…
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Medication-Overuse Headache
Etiology: Main Risk Factors with Odds Ratio Epidemiology: Pathophysiology: History and Physical: Treatment/Management: Differential Diagnosis: Prognosis: Complications:
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Delirium
1. Acute Onset with Fluctuating Course 2. Transient Disturbance of Consciousness 3. Confusion or Disorganized Thinking 4. Altered Level of Consciousness 5. Disturbed Sleep/Wake Cycle 6. Altered Psychomotor Activity 7. Perceptual Disturbances 8. Disorientation 9. Memory Impairment Common causes include (multiple often): DDx Delirium Demetia Psychosis Onset Sudden slow onset…
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Transient global amnesia
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Stroke
Thrombolysis contraindications Absolute ‘BRAIN VAIN’ (we want to protect the brain!) Bleeding diathesis Recent head trauma (<3/12) Active bleeding Ischaemic stroke (<3/12) Neoplasm (intracranial, malignant) Vascular abnormality (intracranial) Aortic dissection (suspected) Intracranial haemorrhage (ever) Non-STEMI! (Not completely correct – could ne new LBBB, but I had to put something here!)…
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TIA
History neurological examination Risk factor assessment and stratification >60 years (1 point) >140mmHg systolic ± =90mmHg diastolic (1 point) unilateral weakness (2 points) speech impairment without weakness (1 point) 60mins (2 points) 10-59 mins (1 point) Acute management of TIA Carotid Endarterectomy : Indication Secondary prevention *In the PROGRESS trial,…
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Brain – anatomy basics
Frontal lobe
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Myasthenia gravis
Incidence prognosis associated immune disorders Triggers for Myasthenia Gravis and Myasthenia crisis Clinical EXAMINATION DIFFERENTIALS Associated symptoms presented with muscle weakness Disease Symptoms Dermatomyositis Skin rash, e.g., upper eyelids (heliotrope rash), erythema of the knuckles (Gottron rash), anterior chest (v sign), or back (shawl sign)Weight loss, anorexia, bleeding tendency, abnormal…
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Multiple Sclerosis
Early clinical and imaging features affecting prognosis in multiple sclerosis Better prognosis Poor prognosis Optic neuritis or isolated sensory symptoms as the initial presentationComplete recovery from the first neurological episodeLong interval to second relapseNo disability after five yearsNormal initial MRIOlder age at disease onset High relapse rate in first 2–5 yearsSubstantial disability…
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Motor neurone disease
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Muscle weakness
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Huntington’s
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Progressive Supranuclear palsy
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Tremor
Classification Rest Tremor Postural Tremor Action Tremor Examination Investigations Essential Tremor Physiologic Tremor
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Parkinsons Disease
SIGNS and SYMPTOMS Tremor Rigidity Bradykinesia Postural Instability Freezing Other Manifestations DIFFERENTIAL DIAGNOSES OF PARKINSON’S DISEASE following features are not usually part of Parkinson’s disease: Parkinson Disease Examination Rigidity, Bradykinesia and Tremor Investigations: Consider Parkinsons plus syndromes Red flags for these include: (table in murtaghs pg 298) Hoehn and Yahr…
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Restless legs syndrome
Primary and Secondary Forms four essential features: Investigations Management Medications Mild and infrequent, use: More severe symptoms: Augmentation is when the symptoms of restless legs and periodic limb movements of sleep/wakefulness get worse after treatment—the symptoms may shift to an earlier time in the day, have greater intensity and involve…
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Narcolepsy
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Insomina
characterized by Age Recommended sleep time (hours) Not recommended sleep time (hours) 18 to 25 years 7 to 9 less than 6 or more than 11 26 to 64 years 7 to 9 less than 6 or more than 10 older than 65 years 7 to 8 less than 5…
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Sleep Disorders
Disorder Symptoms and signs Most effective treatment Delayed sleep phase syndrome Late sleep onset and wake-up time Bright light therapy in the morninglow-dose melatonin in the evening Insomnia Difficulty initiating or maintaining sleep, daytime sleepiness with inability to nap, daytime impairment (e.g., difficulty with memory, concentration, attention; worry about sleep;…
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First time seizure
Differentials “SICK DRIFTER” Medications (partial list) Vital Signs Metabolic Bupropion, Camphor, Clozapine, Cyclosporine, Fluoroquinolones, Imipenem, Isoniazid, Lead, LidocaineLithium, Metronidazole, TheophyllineTCAs , Baclofen Hypoxia HyperthermiaHTN Emergency Hepatic Encephalopathy UremiaHypoglycemia Hyperglycemia Withdrawal Syndromes Infectious CNS Abnormalities Alcohol AEDsBenzoz EncephalitisCNS AbscessMeningitis Traumatic Brain InjuryTIASAHCVATraumatic ICH SOL (i.e. Tumor) Electrolytes mimic seizures Pseudoseizures HypocalcemiaHypercalcemiaHyponatremiaHypomagnesaemia EclampsiaMigraine prodromeNonepileptic seizures/ pseudoseizuresSyncopeAcute…
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Epilepsy & Women
The big issues are… PubertyMenstruationMenopause ContraceptionPregnancy & Breast feedingPolycystic Ovaries Disease Puberty and Epilepsy Menstruation and Epilepsy Menopause Contraception Antiepileptics that interferes with the OCP Antiepileptics that DO NOT interfere with the OCP CarbamazepinePhenytoinPhenobarbitonePrimidoneTopiramateOxcarbazepineClonazepamClobazam Sodium valproateGabapentinLamotrigineTiagabineLevetiracetamVigabatrinEthosuximide → additional contraceptive methods are strongly recommended. Pregnancy Epilepsy and Babies: Key Points Healthy…
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Seizures
Classification of Seizures (isuri notes…) Partial Seizures – occur within discrete regions of the brain Simple Partial Seizures (jaksonian epilepsy) Complex Partial Seizures Partial Seizures with Secondary Generalisation Generalised Seizures – arise from both cerebral hemispheres simultaneously Absence Seizures (Petit Mal) Atypical Absence Seizures Clinical Feature Absence Seizures…
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Post lumbar puncture headahce
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Cervicogenic Headache
Cervical Spinal Nerves Innervated Joints Referred Pain C1 Atlanto-occipital joint Occipital region of the head C2 Atlanto-axial and zygapophyseal joints Occipital, frontotemporal, and periorbital regions of the head C3 Zygapophyseal joint Occipital, frontotemporal, and periorbital regions of the head
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Hemicrania
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Cluster headache
Calcification of Trigeminal autonomic cephalalgias (TACs) Differential Diagnosis Management Prophylaxis
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Tension Headache
Tension-type headaches (50% incidence) Migraine(25%) Nature of pain Non-pulsatile band, Tight gripping pressure, constant, no effect of head movement Throbbingpulsatingworsening of pain with movement Site of pain Bitemporal, occipital or generalised (may be retro-orbital, may be band-like) Unilateral (often in temple or retro-orbital) Associated features Often at end of dayFew…
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Papilledema
differentials
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Idiopathic intracranial hypertension
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Migraine
classification Defined as: At least five attacks with four phases Prodrome / aura / headache / postdrome Tips and traps in diagnosis SNNOOP10 list of red and orange flags Red flag Related secondary headache Systemic symptom/fever Intracranial infection, carcinoid or phaeochromocytoma History of neoplasm Metastatic disease Focal neurological deficit Stroke,…
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Headache
primary headache disorders: Primary frequent (chronic daily) headache disorders secondary headache disorders Red flag headaches Type of Medical Condition Signs and Symptoms metastases New headache in the setting of cancer opportunistic infection New headache in the setting of HIV infection Subdural haematoma New headache postmanipulation or trauma of the neck,…
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Facial pain
may not be identified by clinical assessment. Maxillary sinusitis Trigeminal neuralgia Glossopharyngeal neuralgia Facial migraine Elongated styloid process (Eagle’s syndrome) Symptoms Diagnosis Treatment Cranial (temporal) arteritis Temporomandibular joint dysfunction aetiology clinical features DDx Investigations management
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Alcoholic polyneuropathy
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Diabetic polyneuropathy
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PERIPHERAL NEUROPATHY
Demyelination Damage to Schwann cell causes myelin disruption and slowing of nerve conduction. Examples include GuillainBarr syndrome, diphtheria, hereditary sensorimotor neuropathies and Chronic Inflammatory Demyelinating polyneuropathy (CIDP). Axonal degeneration The axon dies back from the periphery. Examples include Diabetes, metabolic conditions and toxic neuropathies such as drugs and alcohol. Wallerian…
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Horner’s Syndrome
indrawn eye + small pupil + ptosis (± anhydrosis) → Horner syndrome (?lung cancer) as per Murtag Causes: Investigations
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Cranial nerve palsies
6th nerve palsy Third cranial nerve palsy “down and out” 4th cranial nerve palsy
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Bells palsy
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Herpes Zoster Ophthalmicus
VZV distributions of the fifth cranial nerve (trigeminal nerve), shared by the eye and ocular adnexa Red Flags Background Risk Factors History Examination Signs Specific Examination Components Differential diagnosis Management of Herpes Zoster Ophthalmicus (HZO) Skin Rash Treatment Ocular Treatment Antiviral Therapy Systemic/Oral Prednisolone Elevated Intraocular Pressure (IOP) Pain Management…
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Herpes Zoster/Shingles
Pathophysiology of Varicella-Zoster Virus (VZV) Infection Chickenpox (Primary VZV Infection): Chickenpox is caused by the primary infection with Varicella-Zoster Virus (VZV). During the initial infection, the virus spreads throughout the body, primarily affecting the skin and respiratory tract. This results in the characteristic widespread vesicular rash of chickenpox. The virus…
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facial weakness causes
Causes of facial weakness NeurologicalStroke (upper motor neuron palsy)Guillain–Barré syndromeMultiple sclerosisOtologicAcute or chronic otitis mediaMalignant/necrotising otitis externaCholesteatomaSchwannomaInfectiousHerpes zoster virusMumpsRubellaEpstein–Barr virusInflammatorySarcoidosisNeoplasticCerebral tumourCutaneous cancer of the face and neckParotid tumourMetastatic tumourLymphomaIdiopathicBell’s palsyTraumaTemporal bone fractureSurgical intervention with subsequent damage to the facial nerve
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Head injury (kids)
Primary survey and resuscitation: A Alert V Responds to voice P Responds to pain U Unresponsive Assess pupil size, equality and reactivity Initial management flowchart: Secondary survey: Perform a formal Glasgow Coma Score (GCS) Neck and cervical spine Head Eyes Ears Nose Mouth Face Motor function * suspect basal skull fracture if these signs present Features…
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Concussion
A concussion is a mild traumatic brain injury (mTBI) A concussion occurs after a strong blow to the head or significant shaking and the brain has been injured. Advice for Patients Regarding Concussions: Immediate Action Post-Injury:– Rest: Take it easy for the first 24-48 hours after the injury. Avoid physical…