Skull Anatomy

Pterion formed of joining of parietal, frontal, sphenoid and temporal Trauma \(\rightarrow\) ruptured middle meningeal \(\rightarrow\) extra…

Neurovasculature

Artery Area Anterior cerebral artery supply Superior and medial frontal and parietal - Corpus c…

Brain fibre types

Fibre types Associated fibres - connection areas within a hemisphere eg cingulum Commissural fibres - interconnect areas between hemispheres …

Control pathways

  Ascending Pathways Dorsal column Fine touch, vibration, proprioception Runs ipsilaterally - decussate in medulla Sensation…

Stroke Treatment Choice

Thrombectomy + thrombolysis for people with ischaemic stroke <6h. Thrombectomy if limited infarct

Stroke symptoms per artery

    PICA - vertigo, vomiting dysphagia, ipsilateral facial pain & temperature loss, contralateral limb pain & t…

\(\uparrow\) ICP signs

Long intracranial course of abducens (CN VI) makes it suseptible to damage early in increased ICP  Innervates lateral rectus so the affecte…

Autonomic division

Only carried within segmental spinal nerves: Sympathetic - T1-L2, highly organised, widespread effect. Ganglion in sympathetic chain Par…

Spinal reflexes

Reflex Sensory afferent Proposed function Myotactic (stretch) reflex Muscle spindle - 1a afferent Muscl…

Cerebellum

Always and completely ipsilateral Vestibulocerebellum (Archicerebellum) - Flocculonodular lobe, part of vermis. Balance and eye movements Sp…

Visual pathway

All info goes via lateral geniculate nucleus of thalamus - Upper visual field goes to lower bank of calcarine sulcus and vice versa

Auditory pathway

Ossicles: Malleus, Incus, Stapes (MIS) Oval window transmits the waves, round window releases them Hair cells sit on basilar membrane with tip…

Neurogenic bladder

Inability to properly empty bladder due to neurological damage. UMN → spastic LMN → flaccid. Secondary infections an…

Meningitis in infants

Non-specific clinical presentation in infants Viral - more common Enteroviruses 50% HSV, influenza, EBV, adenovirus, CMV Bacterial: …

Meningococcaemia

Mortality 5-10% (90% if DIC), morbidity 10% Maculopapular rash

CSF abnormalities in meningitis

Condition Appearance Cells Protein Glucose Normal Clear, colourless 0-5 lymphocytes   …

Acute progressive viral encephalitis

Highest case fatality of any infectious disease Prodromal phase - fever, nausea, vomiting, headache, fatigue, tingling at site of wound Furio…

Lead Poisoning

This condition classically presents with abdominal pain, constipation, peripheral neuropathy (mainly motor) and neuropsychiatric features. Haematolog…

Dementia progression

Anti-coagulation in Stroke with AF

If the CHADVASc score is higher than ORBIT anticoagulate

Parkinsonism features

TRAP features - Tremor - pill rolling / lead pipe tremor - resting - Rigidity - Akinesia/bradykinesia key - reduced blink, face expression,…

Radiculopathies

Spinal roots are compressed or inflamed Pain Weakness Numbness Tingling Commonly due to: Disc herniation Spinal stenosis D…

Bell's Palsy

Facial paralysis resulting from inflammation or compression of facial nerve (CN VII) Sudden onset Unilateral Drooping of the eyelid and cor…

Encephalitis

Inflammation of the brain usually viral - HSV, West Nile, enterovirus Fever Headache AMS Seizures  Focal neurological deficits …

Multiple Sclerosis

Relapsing remitting autoimmune condition - demyelination in the central nervous system Episodes of neurological dysfunction includi…

Headaches

Type Description Cause Triggers Treatment Migraine Recurrent, throbbing headaches often accompanied…

Meningitis

Bacterial causes - medical emergency: IM Benpen in GP When in hospital - if <3 months or >50 years = IV cefotaxine + amox Otherwise in…

Epilepsy

Seizure type Location Before During After Treatment Generalised tonic-clonic seizures (grand mal) …

Space occupying lesion symptoms

Progressive focal neurological symptoms Space occupying → ICP & associated symptoms Constant headache Nocturnal (occurring a…

Vasovagal Syncope

Autonomic nervous system - vagus nerve stimulation, sudden parasympathetic nervous system stimulation due to event   BEFORE …

Syncope vs Seizure

Syncope Seizure Prolonged upright position before the event Epilepsy aura (smells,…

Brachial plexus

Brain fibre types

Association - between areas in the same hemisphere eg cingulate gyrus Commissural - between areas in different hemispheres eg corpus callosum P…

Brainstem rule of 4s

4 structures in the midline beginning with M motor pathway (corticospinal) medial lemniscus  motor nuclei for cranial nerves medial …

Brain tumours

Gliomas Glial cells - astrocytes, oligodendrocytes and ependymal cells. Gliomas are graded from 1 to 4. Grade 1 is the most benign (possibly cu…

Lambert–Eaton Syndrome

Lambert–Eaton myasthenic syndrome is a rare autoimmune disorder characterised by muscle weakness of the limbs. Around 60% of those with LEMS ha…

Syringomyelia

Fluid-filled cyst (syrinx) forms within the spinal cord classically presents with cape-like loss of pain and temperature sensation

Seizure symptoms per region

Temporal lobe - seizures occurring here are associated with epigastric auras and automatisms. Other auras may be deja vu, or auditory, gustatory…

B12/folate deficiency

Always treat B12 deficiency first - giving patients folic acid when they have a B12 deficiency can lead to subacute combined degeneration o…

Wernicke-Korsakoff syndrome

Alcohol prevents the absorption of thiamine by blocking thiamine pyrophosphate synthetase, resulting in thiamine deficiency. The main sy…

Levodopa

Drug Class Dopamine precursor Mechanism Crosses blood-brain barrier and converted by enzyme dopa decarboxylase …

Phenytoin

Drug Class Anti-convulsant Mechanism Alters transmembrane movement of Na+/K+ by blocking voltage-gated Na+ channels -…

Carbamazepine

Drug Class Anti-convulsant Mechanism GABA-mediated inhibitory transmission in the CNS  Typical Dose …

Sodium Valproate

Drug Class Anti-convulsant Mechanism ↑ GABA content of the brain - inhibits GABA re-uptake …

Metoclopramide

Drug Class Antiemetic (dopamine antagonist) Mechanism Blocks dopamine receptors in chemoreceptor trigger z…

Lamotrigine

Drug Class Anti-convulsant Mechanism Binds and inhibits voltage-gated sodium channels, stabilizing presynaptic neuron…

Drugs to avoid in Lewy Body Dementia

Avoid HARM drugs H- haloperidol A- antipsychotics (in general) R- pRochlorperazine M- metoclopramide

Ramsay Hunt syndrome

  Ramsay Hunt syndrome (herpes zoster oticus) is caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the s…