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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