Rapid Neurology and Neurosurgery E-Book

Kumar Abhinav

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Rapid
• Sprache: Englisch

Seitenzahl: 291

Veröffentlichungsjahr: 2012

Beschreibung

RAPID Neurology & Neurosurgery

The Rapids are a series of two-colour reference and revision pocket books that cover key facts in a simple and memorable way. Each book covers the common conditions or drugs that students and junior doctors encounter on the wards, in clinics, and in their exams. The core relevant facts are provided to ensure these books are perfect concise ‘rapid refreshers’. To see all titles in the series, go to: www.wiley.com/go/rapids

Rapid Neurology and Neurosurgery is a must for all medical students and junior doctors-it is a quick and easy on-the-ward or clinical reference and the perfect revision tool for those approaching finals, undergraduate neurology and neurosurgery examinations and the Membership of Royal College of Surgeons (MRCS) examinations.

It provides a concise, structured approach to neurology and neurosurgery learning, covering key fact in a simple and memorable way:

PART I (The Basics) features the basic principles and facts essential for a good understanding of neurology and neurosurgery and includes sections on relevant neuroanatomy, neurological history and examination, and investigation including neurophysiology and neuroradiology. MRI and CT scans are included throughout the text.

PART II (Complaints: Face-to-Face with the patient) features OSCE-style and viva-voce examination preparation and has chapters on presenting complaints, with relevant and selected questions to ask for establishing the differential diagnoses (presented in a table) with basic investigations and management.

PART III (Conditions: Applying the basics) presents important clinical conditions with sections on definition, epidemiology, aetiology, associations/risk factors, pathology, history, examination, investigations, management, complications, prognosis and a list of differential diagnoses with general clinical information and distinguishing information to exclude the alternative diagnoses.

Each chapter includes key points to remember and highlights key facts.

Rapid Neurology and Neurosurgery contains only the essential, core, and relevant facts in a concise, pocket-sized, ‘rapid’ refresher-providing a thorough foundation of neurology and neurosurgery knowledge that will allow you to excel in the examinations.

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Leseprobe

Contents

Cover

Title Page

Copyright

List of Abbreviations

Preface

Acknowledgements

Part I: The Basics

Chapter 1: About this Book and How to Use it

Chapter 2: Basic Neuroanatomy

Cortical Anatomy

Brainstem and Cranial Nerves (CN)

Cerebellum

Vascular Anatomy (Cranial)

Spinal Cord

Peripheral Nervous System

Chapter 3: Neurological History, Examination, Signs and Localisation

‘Where’

‘What’

‘Why’

The Neurological History

Neurological Examination

Chapter 4: Neurological Investigations

Neurophysiology

Neuroradiology

Lumbar Puncture and CSF Analysis

Part II: Complaints: Face-to-Face with the Patient

Chapter 5: Headache

Useful Selected Questions to Ask/Facts to Establish?

Other Points to Consider

Differential Diagnoses (see Chapter 12)

Chapter 6: Blackouts

Useful Selected Questions to Ask/Facts to Establish (Syncope Versus Seizures)

Differential Diagnoses (Table 6.1)

Chapter 7: Visual Disturbances

Loss of Vision

Diplopia (Double Vision)

Chapter 8: Dizziness and Vertigo

Useful Selected Questions to Ask/Facts to Establish?

Differential Diagnoses (Table 8.1)

Chapter 9: Weak Legs

Useful Selected Questions to Ask/Facts to Establish?

Differential Diagnoses (Table 9.1)

Chapter 10: Numbness and Sensory Disturbance

Useful Selected Questions to Ask/Facts to Establish?

Differential Diagnoses (Table 10.1)

Chapter 11: Gait Assessment and Disturbance

Useful Selected Questions to Ask/Facts to Establish (During Gait Assessment)

Differential Diagnoses

Basic Management

Part III: Conditions: Applying the Basics

Chapter 12: Headache

Migraine

Tension-type Headache

Cluster headache

Brief Notes on Other Conditions Causing Headache

Chapter 13: Transient Ischaemic Attacks (TIAs)

Chapter 14: Stroke I: Thromboembolic Stroke and Syndromes

Clinical Syndromes

Stroke Units

Thrombolysis

Aspirin

Note on Rehabilitation

Chapter 15: Stroke II: Intracerebral Haemorrhage

Chapter 16: Stroke III: Subarachnoid haemorrhage

Chapter 17: Epilepsy

Chapter 18: Multiple Sclerosis

Chapter 19: Parkinson's Disease and Other Related Syndromes

Chapter 20: Other Movement Disorders

Tremor

Chorea

Dystonia

Chapter 21: Central Nervous System Infections: Meningitis

Note on CSF Shunt Infections

Chapter 22: Central Nervous System Infections: Cerebral Abscess

Chapter 23: Radiculopathy and Disc Herniation

Note on Red Flag Signs for Imaging

Chapter 24: Peripheral Neuropathies' Syndromes

Guillain–Barré syndrome

Note on Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)

Chapter 25: Common Peripheral Nerve Lesions: Mononeuropathies

Chapter 26: Motor Neurone Disease (MND)

Chapter 27: Myasthenia Gravis and Lambert–Eaton Myasthenic Syndrome

Chapter 28: Diseases of the Muscle

The Treatable Inflammatory Mmyopathies

Chapter 29: Alzheimer's Disease and Other Dementia Syndromes

Chapter 30: Raised Intracranial Pressure and Herniation Syndromes

Notes on Differential Diagnoses (see also Chapter 31 on Coma)

Chapter 31: Coma and Brainstem Death

Criteria for Diagnosis of Brainstem Death

Chapter 32: Head Injury: General Approach and Management

Note on Differential Diagnoses

Chapter 33: Head Injury: Subdural Haematoma, Skull Fractures and Contusions

Other Conditions of Note (Table 33.1)

Chapter 34: Head Injury: Extradural Haematoma

Chapter 35: Spinal Injuries and Spinal Cord Syndromes

Notes on Common Cervical Spine Fractures

Chapter 36: CNS Neoplasia

Chapter 37: Hydrocephalus

Appendices

Appendix 1: Management of Status Epilepticus (SE)*

Appendix 2: Glasgow Coma Scale (GCS)

Appendix 3: Primary Neuroepithelial Tumours of the Central Nervous System

Appendix 4: Other Tumours Affecting the Central Nervous System

Index

This edition first published 2012 © 2012 by John Wiley & Sons, Ltd

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Library of Congress Cataloging-in-Publication Data

Abhinav, Kumar.

Rapid neurology and neurosurgery / Kumar Abhinav, Richard Edwards, Alan Whone.

p. ; cm. – (Rapid series)

Includes bibliographical references and index.

ISBN 978-0-470-65443-9 (pbk. :alk. paper)

I. Edwards, Richard (Richard John) II. Whone, Alan. III. Title. IV. Series: Rapid series.

[DNLM: 1. Nervous System Diseases–Handbooks. 2. Neurosurgical Procedures–Handbooks.

3. Trauma, Nervous System–Handbooks. WL 39]

616.80076–dc23

2012009836

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover image: iStock © Sebastian Kaulitzki

Cover design by Fortiori Design

List of Abbreviations

ABCAirways and breathing and circulationADAlzheimer's diseaseADEMAcute disseminated encephalomyelitisADHDAttention deficit hyperactivity disorderAEDAntiepileptic drugAFAtrial fibrillationALSAmyotrophic lateral sclerosisAPPAmyloid precursor proteinASDHAcute subdural haematomaAVMsArteriovenous malformationsBNFBritish National FormularyBPVBenign positional vertigoCAACerebral amyloid angiopathyCADASILCerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathyCBFCerebral blood flowCESCauda equina syndromeCIDPChronic inflammatory demyelinating polyneuropathyCMAPCompound muscle action potentialCNCranial nerveCNSCentral nervous systemCPPCerebral perfusion pressureCSDHChronic subdural haematomaCTComputed tomographyCTACT angiographyCTSCarpal tunnel syndromeCVRCerebral vascular resistanceDAIDiffuse axonal injuryDBSDeep brain stimulationDINDDelayed ischaemic neurological deficitDVLADriver and Vehicle Licensing AgencyDVTDeep venous thrombosisEEGElectroencephalogramEMGElectromyographyEMQExtended matching questionsETEssential tremorETVEndoscopic third ventriculostomyEVDExternal ventricular drainFTDFrontotemporal dementiaFVCForced vital capacityGCAGiant cell arteritisGBMGlioblastoma multiformeGBSGuillian–Barré syndromeGCSGlasgow Coma ScaleGTCGeneralised tonic–clonicHACEHigh altitude cerebral oedemaICHIntracerebral haemorrhageICPIntracranial pressureIIHIdiopathic intracranial hypertensionINOInternuclear opthalmoplegiaIVIGIntravenous immunoglobulinLACSLacunar strokeLEMSLambert–Eaton myasthenic syndromeLBDLewy body dementiaLMNLower motor neuroneLOCLoss of consciousnessLPLumbar punctureLPLumboperitonealMAPMean arterial pressureMCIMild cognitive impairmentMCQMultiple choice questionsMDTMultidisciplinary teamMGMyasthenia gravisMNDMotor neurone diseaseMRAMR angiographyMRCMedical Research CouncilMRIMagnetic Resonance ImagingMSMultiple sclerosisMUPsMotor unit potentialsNAHINon-accidental head injuryNCSNerve conduction studiesNMJNeuromuscular junctionNPHNormal pressure hydrocephalusOCSPOxford Community Stroke ProjectOSCEObjective Structured Clinical ExaminationsPACSPartial anterior circulation strokePBPProgressive bulbar palsyPCCProthrombin complex concentratePDParkinson's diseasePEPulmonary embolismPEGPercutaneous endoscopic gastrostomyPFOPatent foramen ovalePLSPrimary lateral sclerosisPMAProgressive muscular atrophyPNSPeripheral nervous systemPOCSPosterior circulation strokePPMSPrimary progressive multiple sclerosisPRESPosterior reversible encephalopathy syndromePTAPosttraumatic amnesiaRAPDRelative afferent pupillary defectRASReticular activating systemREZRoot entry zoneRRMSRelapsing/remitting multiple sclerosisRTARoad traffic accidentsSACDSubacute combined degeneration of the cordSAHSubarachnoid haemorrhageSCISpinal cord injurySCMSternocleidomastoidSEStatus epilepticusSEMSpinal extradural metastasesSPMSSecondary progressive multiple sclerosisTACSTotal anterior circulation strokeTBITraumatic brain injuryTIAsTransient ischaemic attacksTNTrigeminal neuralgiaUMNUpper motor neuroneVAVentriculoatrialVPVentriculoperitoneal

Preface

My late grandfather, a university professor, used to talk about the so-called ‘ideal’ students, who read extensively on a topic prior to attending the relevant lecture, made their own ‘notes’ in their own ‘words’ in a summarised fashion, which they subsequently memorised in the lead up to the exams. This inspirational philosophy with respect to teaching and the ‘ideal’ learning method can be difficult to adhere to as a modern medical student, where the ever-increasing breadth of the curriculum makes it difficult to both identify the pertinent information and then assimilate it in preparation for the exams.

Our objective was to put together a book in a condensed format, which gave the necessary basic information for building a solid foundation in neurology and neurosurgery required by medical students and junior doctors, and then followed it up with sections on presenting complaints and all the key clinical conditions. This book aims to simplify information in specialties traditionally considered ‘difficult’, to which medical students have variable and usually limited exposure, and to facilitate focused exam preparation. We really hope differential diagnoses tables, a consistent feature across this book, are helpful particularly for OSCE and EMQ sections of the exam and are used to refresh knowledge from other cross-referenced chapters during revision.

We sincerely hope this easy-to-use and concise book with ample practical information is useful for exams and as a reference guide on the wards and clinics for medical students, junior doctors and other health professionals in neurology and neurosurgery.

Kumar Abhinav

Richard Edwards

Alan Whone

Acknowledgements

We are indebted to all those who provided helpful advice at different stages of the production of the book. We are also grateful to the medical students and junior doctors who provided invaluable advice regarding improving the contents of the book. Specifically, we would like to acknowledge the following at Frenchay Hospital, Bristol: Mr Kristian Aquilina, Consultant Neurosurgeon for authoring the chapters on meningitis and cerebral abscess; Dr Philip Clatworthy, Specialist registrar in Neurology and Stroke Medicine, for his contribution towards the chapters on transient ischaemic attacks and thromboembolic stroke and syndromes, and Mr Devindra Ramnarine, Senior registrar in Neurosurgery, for his feedback regarding the chapter on radiculopathy and disc herniation. We would further like to thank all our colleagues at the Wiley-Blackwell: in particular, Martin Davies for his support through the initial stages of the book proposal and Laura Murphy for her guidance through the preparation of the manuscript. Finally, we are immensely thankful to our partners and families for their encouragement and patience through the preparation of the book and particularly to Melanie Yoogalingam for her help and support throughout this endeavour.

Part I

The Basics

Chapter 1

About this Book and How to Use it

The principal purpose of this book is to act as a quick revision tool for medical students approaching finals or other undergraduate neurology/neurosurgery exams. Although the book is intended as a quick revision tool, using it diligently and devoting time to understanding the basic concepts outlined herein will allow you to neurologically flourish rather than simply pass exams. The book is designed for both the newer type of written exams, including multiple choice questions (MCQ) as well as the extended matching questions (EMQ), and traditional exams requiring long and short answers. This book is also designed to prepare you for the Objective Structured Clinical Examinations (OSCE); in particular, Part II is geared towards this purpose.

The book is divided into three parts. Part I gives you the necessary basic principles and facts essential for building a foundation in clinical neurology/neurosurgery at an undergraduate level. Only clinically relevant neuroanatomy is presented along with an introduction to the topics of neurological history, examination and investigations. In particular, we have tried to simplify neuroradiological concepts and presented the rationale for using different imaging modalities.

Part II is very much geared towards the OSCE and the viva voce exams in finals. This section consists of chapters dealing with various presenting complaints. Lists of focussed and discriminating questions for determining the important differential diagnoses are included in these chapters along with tables listing the relevant disease entities in order of incidence. Please note, however, that you will also be expected to ask other relevant questions not listed in the chapters while taking a detailed history, including past medical history, drug history and social history. Additional important clinical information for each presenting complaint is included. The tables of potential differential diagnoses are supplemented by information on basic investigations and management. Again, in an exam setting you will have to be guided by the clinical information and suggest a list of focussed and relevant investigations! This part of the book can also act as a worthy quick reference on wards and in clinics.

Part III presents the important clinical neurological and neurosurgical conditions with focussed pertinent clinical information. Neurological topics are presented first followed by neurosurgical topics with the exception of the chapter on subarachnoid haemorrhage, which is included under ‘stroke’. Part III like other parts is interspersed with sentences beginning with ‘Remember . . .’ and designed to highlight key facts from the chapter. At the end of each chapter there is a list of common differential diagnoses (up to a maximum of four–five) for the particular condition described. General clinical details are provided, including, where applicable, information that can be used to distinguish between or exclude the alternative conditions. This should be of particular help for the EMQ section of the exam and will also prove useful in the OSCE when presenting a list of potential differential diagnoses.

Some of the chapters in the book may not strictly follow the format as laid out above and will generally be due to the nature of the topic and thereby the limitations of presenting it in a specific format.

We hope that the format; organisation and simple language employed will facilitate quick and effective revision and will help you perform well in all sorts of undergraduate examinations. Moreover, we trust this book will permit a better understanding of the basic concepts underpinning neurology and neurosurgery and thus provide a firm basis upon which to build your clinical neurological/neurosurgical expertise as you journey through your medical career.

Good Luck!

Chapter 2

Basic Neuroanatomy

The following section aims to present only the very relevant anatomical information.

Cortical Anatomy

Figure 2.1 demonstrates the following relevant key areas on the cortical surface:

Figure 2.1 Lateral surface of cerebral hemisphere demonstrating cortical surface anatomy.

Remember: The association between dominant hemisphere and speech areas and therefore a further important point about ascertaining handedness of patients at the beginning of obtaining a neurological history.

Figure 2.1 Lateral surface of cerebral hemisphere demonstrating cortical surface anatomy.

Primary motor cortex: Situated anterior to central sulcus (frontal lobe) in the precentral gyrus; involved in contralateral motor function—Brodmann's (Br.) Area 4.