Comprehensive notes on Neurology and Neurosurgery for the University of Cambridge Medical course. Written by a top decile student. It will be covering:
1) Cerebrovascular Disease including Stroke
2) Loss of Consciousness including Epilepsy
3) Movement Disorders
4) Inflammatory and Infectious ...
Neurology and Neurosurgery
Cerebrovascular 1. Stroke
Disease 2. Transient Ischaemic Attack (TIA)
3. Primary Intracerebral Haemorrhage
a. Intracerebral Haemorrhage
b. Subarachnoid Haemorrhage
c. Subdural Haematoma
d. Extradural Haematoma
e. Cavernous Sinus Thrombosis
4. Carotid Artery Dissection
5. Head Injury
Loss of 1. Epilepsy
Consciousness 2. Status Epilepticus
3. Febrile Convulsions
4. Syncope
a. Vasovagal
b. Carotid Sinus Hypersensitivity
5. Encephalopathies
a. Wernicke’s Encephalopathy
Movement 1. Akinetic-Rigid Syndromes
Disorders a. Parkinson’s Disease
b. Drug-induced Parkinson’s
c. Parkinsonism Plus
2. Dyskinesias
a. Benign Essential Tremor
b. Chorea
c. Huntington’s Disease
3. Tremor
4. Other Movement Disorders
5. Multiple Sclerosis
6. Gaits
Infections and 1. Meningitis
Inflammation of 2. Encephalitis
the Nervous 3. Cerebral Abscess
System 4. Spinal Epidural Abscess
5. Neurosyphilis
6. Transmissible spongiform encephalopathy
7. HIV
8. Brain Tumours
a. Vestibular Schwannoma
9. Hydrocephalus
Headache 1. Tension Headache
2. Migraine
3. Cluster Headache
4. Medication Overuse Headache
5. Trigeminal Neuralgia
6. Postherpetic Neuralgia
7. Giant Cell Arteritis
, 8. Raised ICP
9. Vascular Causes
a. Carotid Artery Dissection
Spinal Cord 1. Spinal Cord Compression
Disease 2. Cauda Equina Syndrome
3. Cervical Spondylosis
4. Spinal Root Radiculopathy
a. Intervertebral Disc Prolapse
5. Spinal Stenosis
a. Lumbar Spine Stenosis
b. Cervical Spine Stenosis
6. Syringomyelia
7. Brown-Sequard Syndrome
Degenerative 1. Motor Neuron Disease
Conditions 2. Frederich’s Ataxia
3. Dementia
a. Alzheimer’s Disease
b. Dementia with Lewy Bodies
c. Frontotemporal Dementia
d. Vascular Dementia
e. CJD
f. Huntington’s Disease
g. Normal Pressure Hydrocephalus
4. Delirium
5. Aphasia
Disorders of the 1. Mononeuropathies
Peripheral a. Carpal Tunnel Syndrome
Nervous System b. Mononeuritis multiplex
2. Polyneuropathies
a. Guillan-Barré Syndrome
b. Vitamin Deficiencies
3. Muscle Disease
a. Dermatomyositis
b. Myasthenia Gravis
c. Lambert-Eaton Syndrome
d. Muscular Dystrophy
4. Myotonia
5. Neuropathic Pain
Disorders of the 1. Visual Field Defects
Cranial Nerves 2. Pupillary Defects
3. Trigeminal Neuralgia
4. Facial Nerve Palsies
Weakness
,Cerebrovascular Disease
1. Stroke
Overview
- Stroke = defined as a rapid onset neurological deficit (usually
focal), lasting >24h, which is as a result of a sudden interruption in
the vascular supply of the brain
- Common classifications
o Stroke in evolution - symptoms and signs are getting worse
(usually within 24h of onset)
o Minor stroke - patient recovers without a significant
neurological deficit, usually within 1 week
o Transient Ischaemic Attack - transient episode of
neurological dysfunction caused by focal brain, spinal cord or
retinal ischaemia without acute infarction. No infarction on
imaging.
Ischaemic Haemorrhagic
'Blockage' in the blood vessel Blood vessel 'bursts'
stops blood flow leading to a reduction in
blood flow
Proportio 85% 15%
n
Subtypes Thrombotic Intracerebral haemorrhage
- Atherosclerosis - Trauma
- Prothrombotic state - HTN
- Cerebral amyloid
Embolic
- Usually blood clot. Also Subarachnoid
fat, air, bacteria clumps haemorrhage
- AF - Trauma
- Paradoxical embolus - Berry aneurysm
- Infective endocarditis - AVM
, Lacunar
- Hypertension
Hypoperfusion
- Reduced BP
Risk - Age - Age
Factors - Hypertension - Hypertension
- Smoking - Arteriovenous
- Hyperlipidaemia malformation
- Diabetes mellitus - Anticoagulation
- AF = for cardioembolism therapy
Causes
Common Causes
- Small vessel occlusion/thrombosis in situ
- Cardiac embolism (AF, endocarditis, MI)
- Atherothromboembolism
- CNS Bleeds (Hypertension, trauma, aneurysm rupture,
anticoagulation, thrombolysis)
Less Common Causes
- Sudden BP drop (affects boundary zone between vascular
beds)
- Carotid Artery Dissection
- Vasculitis
- Subarachnoid Haemorrhage
- Venous Sinus Thrombosis
- Antiphospholipid Syndrome
- Thrombophilia
- Fabry Disease
- Cerebral Autosomal Dominant Arteriopathy with subcortical
infarcts and leucoencephalopathy
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