Clinical neurology third edition



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SHORT NOTES ON

CLINICAL NEUROLOGY
THIRD EDITION

Abdel-Latif Moussa Osman

M.D., D.P.M. & N., D.M.

Professor & Chairman

Departments of Neurology

Faculty of Medicine

Al-Azhar University

CAIRO

2004

بسم الله الرحمن الرحيم



"لاَ يُكلِّفُ الله نَفْساً إِلاَّ وُسْعَهَا، لَهَا مَا كَسَبَتْ وَعَلَيْهاَ مَا اكْتسَبَتْ، رَبَّنَا لاَ تُؤَاخذْنَا إن نَسينَا أَوْ أَخْطأْنَا، رَبَّناَ وَلاَ تَحْمل عَلَيْناَ إِصْراً كَماَ حَمَلْتَهُ عَلَى الذينَ مِنْ قَبْلنَا، رَبَّناَ وَلاَ تُحَمِّلْناَ مَا لاَ طَاقةَ لَناَ به، واعْفُ عَنَّا وَاغْفرْ لَناَ وَارْحَمْناَ، أَنْتَ موْلاَناَ فَانْصرْنَا عَلَى الْقَوْمِ الْكَافِرِين"

(البقرة 286)

"... فأَمَّا الزَّبَدُ فَيَذهَبُ جُفَاءً، وَأَمَّا مَا يَنفَعُ النَّاسَ فيمكُثُ فِى الأرْضِ، ..."

(الرعد 17)

Short Notes on Clinical Neurology, 3rd ed. 2004

All rights reserved. No part of this book may be reproduced in any form or by any means, without written permission of the author.

ANDALOSIA FOR PRINTING

TEL: 4024587
National Deposit No

ISBN:
To The Memory of

My Father & Mother


Preface to the Third Edition
The previous two editions of this booklet have been very useful for precisely revising a lot of knowledge in a short time. It has been of great help to medical students, general practitioners, neurophychiatrists & neurosurgeons.
The overall contents have been thoroughly revised & new interesting topics were added.
I hope this new edition will be more informative & interesting for my students & colleagues.
Looking forward to hearing from you.


Abdel-Latif Moussa Osman, MD Cairo, 2004

14 Shehab Street,

Mohandseen, Giza, Egypt

Telephone & Fax: (202) 7605566

(202) 7613513

Mobile : 0123797586



E-mail: aaosman@hotmail.com
Preface to the First Edition
This booklet is intended as a guide for medical students, general practitioners & residents in internal medicine, neurology & neurosurgery. It summarizes the criteria of diagnosis of common neurological diseases & gives a brief account of some important clinical data & diagnostic studies. This guide is not a substitute for textbooks of neurology, but it can help those who have studied the texts to crystallize their knowledge.
I am greatly indebted to my wife & children for their love, devotion, patience & understanding.
I am also indebted to many of my professors, friends, colleagues, students & patients for their cooperation & help.

Abdel-Latif Moussa Osman, MD January, 1985

CONTENTS


Neurology Sheet




Investigations




NEUROLOGICAL SYMPTOMATOLOGY




  • Weakness




  • Wasting




  • Hypotonia




  • Hypertonia




  • Involuntary Movements







  • Chorea




  • Athetosis




  • Dystonia




  • Tremors




  • Sensory Impairment




  • Sensory Ataxia




  • Gait Disorders




  • Neurogenic Bladder




  • Raised Intracranial Pressure




  • The Facial Nerve







  • Bell’s Palsy




  • Facial Pain




  • Ptosis




  • Nystagmus




  • Pseudobulbar Palsy




  • Progressive Bulbar Palsy




  • Hemiplegia




  • Paraplegia




  • Cauda, Conus & Epiconus Lesions




DISORDERS OF CONSCIOUSNESS & EQUILIBRIUM




  • Coma




  • Syncope




  • Vertigo




  • Narcolepsy




  • Autonomic Dysfunction




PAINFUL SYNDROMES







  • Tension-Type Headache




  • Headache Presenting in Emergency Department




  • Trigeminal Neuralgia




  • Low Back Pain & Sciatica




  • Cervical Spondylosis & Brachialgia




SEIZURE DISORDERS




  • The Epilepsies




  • Paroxysmal Conditions Resembling Epilepsy




  • Drug Treatment of Epilepsies (Antiepileptic Drugs)




  • Tonic-Clonic Status Epilepticus




CEREBROVASCULAR DISEASES




  • Blood Supply of the Brain







  • Cerebral Embolism




  • Cerebral Thrombosis




  • Cerebral Haemorrhage




  • Cerebral Arteriosclerosis




  • Subarachnoid Haemorrhage




  • Transient Ischemic Attacks (TIAs)




  • Reversible Ischemic Neurologic Deficit (RIND)




  • Acute Strokes







  • Subarachnoid Hemorrhage (SAH)




  • Intracerebral Hemorrhage




  • Vasculitis of the CNS




CNS INFECTIONS




  • Acute Meningitis




  • Tuberculous Meningitis







  • Herpes Simple & Virus Encephalitis




  • Herpes Zoster




MOVEMENT DISORDERS




  • Parkinson’s Disease (PD)




  • Huntington’s Disease (HD)




  • Rheumatic (Sydenham’s) Chorea




  • Tremor




  • Cerebellar Ataxia




PERIPHERAL NERVE DISEASES




  • Polyneuropathies




  • Guillain-Barre` Syndrome (GBS)




  • Non-inflammatory Peripheral Neuropathies




NEUROMUSCULAR JUNCTION DISEASES




  • Myasthenia Gravis (MG)







  • Congenital Myasthenic Syndromes




  • Neonatal Myasthenia




  • Lambert-Eaton Myasthenic Syndrome (LEMS)




MUSCULAR DISEASES




  • Muscular dystrophies







  • Limb-Girdle Muscular dystrophy




  • Facioscapulohumeral Muscular dystrophy




  • Myotonias




  • Myotonic Dystrophy




  • Myotonia Congenita




  • Periodic Paralysis




  • Polymyositis




DEMYELINATING DISEASES




  • Multiple Sclerosis (MS)







  • Neuromyelitis Optica




  • Acute DEM




  • Acute Transverse Myelitis




NUTRITIONAL DISEASES




  • Pellagra




  • Beriberi




  • Subacute combined Degeneration of the spinal Cord




NEURODEGENERATIVE DISEASES




  • Alzheimer’s Disease (AD)




  • Amyotrophic Lateral Sclerosis (ALS)




  • Normal Pressure Hydrocephalus (NPH)




CNS NEOPLASMS




  • Brain Tumours







  • Childhood Brain Tumors




  • Spinal Cord compression




  • Carcinomatous Meningitis




  • Pseudotumor Cerebri




NEUROLOGICAL COMPLICATIONS OF D. MELLITUS




PSYCHOTROPIC DRUGS




  • Anxiolytics (Minor Tranquilizers)




  • Neuroleptics (Major Tranquilizers)




  • Antidepressants




  • Hallucinogenics (Psychodysleptics)




SEDATIVES & HYPNOTICS




SKELETAL MUSCLE RELAXANTS




NARCOTICS ANALGESICS & ANTAGONISTS




NEUROLOGY SHEET

HISTORY


  1. Personal History :

* Name : ... ... ... ... * Age: ... ... ... * Sex : ... ...

* Occupation : ... ... ... * Address : ... ... * Habits :

* Marital state : ... ... ... * Handedness : ... ... ... ... ...

  1. Complaint:

1. ... ... ... ... ... ... ... ... ... ...

2. ... ... ... ... … ... ... ... ... ...

3. ... ... ... ... … ... ... ... ... ...


  1. Family History :

1. Positive blood consanguinity between the parents.

2. Similar condition in the family.



  1. Past History : (Trauma, fever ,Syphilis, T.B., diabetes, otitis media, rheumatism, billharziasis,.. .etc)

  2. History of the present illness :

(1) Duration: ... ...

(2) Onset: ... ...

(3) Course: ......

(4) Symptomatology (Chronologically): ... ... ... ... ... ... ...

(5) Inquiry about other important symptoms (Symptoms of increased ICT, Cranial nerve affection, Motor, Sensory or Sphincteric troubles).
EXAMINATION


  1. The Mental State :

(1) Attention: ... ... ...

(2) Orientation (for Time, Space & Persons)

(3) Memory (for Recent & Remote events) ... ... ...

(4) Mood:... ... ... ...

(5) Delusions & Hallucinations.


  1. Speech & Artlciglatfosi: ... ... ... ... ... ... ... ... ... ...

  2. Cranial Nerves. Rt. Lt.

- Olfactory: ... ... ... ... ... ... ... ... ... ... ... ...

- Optic (2nd):



* Visual Acuity: ... ... ... ... ... ... ... ...

: ... ... ... ... ... ...

* Fundus: ... ... ... ... ... ... ... ...

- The 3rd, 4th & 6th: ... ... ... ... ... ... ... ... .. ...

* Pupil. ... ... ... ... ... ... .., ... .. . .

* External Ocular Movements (Individual & Conjugate)

* Nystagmus: ... ...

- Trigeminal:

* Motor (temporal muscles, masseters & pterygmds)

* Sensory: ... ... ... ... ... ... ... ...



* Corneal Reflex ... ... ... ... ... ...

* Jaw jerk ... ... ... ... ... ... ... ...

- Facial:

* Motor


  • Upper face ... ... ... ... ... ... ...

  • Lower face ... ... ... ... ... ...

* Taste ... ... ... ... ... ... ... ...

- Auditory (8th):

* Cochlear


  • Whispered Voice ... ... ... ... ... ... ...

  • Watch test ... ... ... ... ... ... ... ...

  • Rinne's test ... ... ... ... ... ... ... ...

  • Weber's test ... ... ... ... ... ... ... ...

* Vestibular

  • Rotational test ... ... ... ... ... ... ... ...

  • Caloric test .. ... ... ... ... ... ... ... ...

- Glossopharyngeal & Vagus (9th & 10th):

* Movement of the Palate & Pharynx (on saying Ah)

* Palatal & Pharyngeal reflexes (gag reflex) ...

* Vocal Cords .. ... ... ... ... ... ... ... ... ...

- Accessory (11 th):

* Trapezii .. ... ... ... ... ... ... ... ... ... ...

* Sternomastoids ... ... ... ... ... ... ... ...

- Hypoglossal (12th): Tongue ... ... ... ... ... ... ... ... ...



  1. The Motor System :

1. Muscle Status & Deformities: ... ... ... ... ...

2. Muscle Tone: ... ... ... ... ... ... ... ... ...

3. Muscle Power: ... ... ... ... ... ... ... ... ... ...

4. Involuntary Movements (including fasciculation)


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