Stroke, epilepsy, MS, Parkinson's, headache syndromes, neuropathies, and neuromuscular conditions — high-yield for postgraduate exams.
Acute unilateral LMN facial nerve (CN VII) palsy of unknown cause (diagnosis of exclusion). Affects all muscles of facial expression on one side (forehead included — distinguishes from UMN lesion). Annual incidence ~20-30 per 100,000. Most recover spontaneously. Prednisolone within 72 hours improves outcomes.
Focal collection of pus within the brain parenchyma, usually caused by bacterial infection. Presents with headache, fever, and focal neurological deficit. Mortality ~10% with treatment. Requires combined surgical drainage and prolonged IV antibiotics.
Primary or secondary neoplasms of the brain. Secondary (metastatic) tumours are the commonest intracranial tumours in adults. Primary tumours include gliomas, meningiomas, and schwannomas. Presentation depends on location — headache, seizures, focal deficit, personality change.
Compression of the median nerve at the wrist within the carpal tunnel. Commonest entrapment neuropathy. Causes pain, paraesthesiae, and numbness in the median nerve distribution (thumb, index, middle, radial half of ring finger). More common in women, pregnancy, hypothyroidism, and diabetes.
Surgical emergency caused by compression of the cauda equina nerve roots (below L1/L2 conus medullaris). Presents with bilateral sciatica, saddle anaesthesia, urinary retention/incontinence, and reduced anal tone. Commonest cause is large central lumbar disc herniation. Requires emergency MRI and decompressive surgery within 48 hours.
Disorders of the cerebellum causing ataxia, dysarthria, nystagmus, intention tremor, and dysdiadochokinesis. Causes include stroke, alcohol, MS, space-occupying lesions, paraneoplastic syndromes, and hereditary ataxias. The mnemonic DANISH PAST covers the key cerebellar signs.
Chronic immune-mediated demyelinating polyradiculoneuropathy causing progressive or relapsing proximal and distal weakness with sensory loss over >8 weeks. Considered the chronic counterpart of GBS. Responds to steroids, IVIg, and plasma exchange.
Severe unilateral periorbital/temporal headache with ipsilateral cranial autonomic features. Attacks last 15-180 minutes, occurring 1-8 times daily in clusters lasting weeks to months. Predominantly affects men. Often called 'suicide headache' due to severity.
Progressive decline in cognitive function affecting memory, thinking, behaviour, and ability to perform everyday activities. Alzheimer's disease is the commonest cause (~60-70%). Affects ~900,000 people in the UK. Diagnosis requires comprehensive cognitive assessment and exclusion of reversible causes.
Commonest cause of peripheral neuropathy in the UK. Affects ~50% of diabetic patients. Distal symmetric polyneuropathy is the predominant form. Major risk factor for diabetic foot ulceration and amputation. Prevention through glycaemic control is key (DCCT/UKPDS trials).
Inflammation of the brain parenchyma causing altered consciousness, behavioural changes, seizures, and focal neurological deficits. HSV-1 is the commonest cause of sporadic viral encephalitis in the UK and is fatal if untreated. Empirical IV aciclovir must be given immediately.
Chronic neurological condition characterised by recurrent unprovoked seizures. Affects ~600,000 people in the UK (~1%). Classified by seizure type (focal, generalised, unknown) and epilepsy syndrome. First-line treatment depends on seizure type. NICE NG217 guides management.
Commonest adult movement disorder characterised by bilateral action/postural tremor (4-12 Hz), typically affecting the hands. Often familial (autosomal dominant with variable penetrance). No associated bradykinesia or rigidity. Improves with alcohol. First-line treatment: propranolol or primidone.
Arterial bleeding between the skull and dura mater, classically from rupture of the middle meningeal artery following temporal bone fracture. Classic lucid interval then rapid deterioration. Biconvex (lens-shaped) on CT. Neurosurgical emergency — mortality <5% if treated promptly.
Seizures associated with fever (≥38°C) in children aged 6 months to 5 years, without CNS infection or other defined cause. Affect 2-5% of children. Simple febrile seizures are benign with excellent prognosis. Complex febrile seizures require further investigation.
Commonest hereditary ataxia. Autosomal recessive trinucleotide repeat disorder (GAA expansion in FXN gene) causing progressive ataxia, cardiomyopathy, scoliosis, and diabetes. Onset typically before age 25. Cardiomyopathy is the leading cause of death. No curative treatment.
Group of neurodegenerative disorders characterised by progressive frontal and/or temporal lobe atrophy. Third commonest cause of dementia overall and commonest cause of dementia in under-65s. Presents with behavioural/personality change or progressive language impairment rather than memory loss.
Large vessel vasculitis affecting branches of the external carotid artery (particularly temporal artery) in patients >50 years. Medical emergency due to risk of irreversible visual loss. Treatment with high-dose corticosteroids must NOT be delayed pending biopsy.
Most common and most aggressive primary malignant brain tumour (WHO grade 4). IDH-wildtype. Median survival ~15 months with optimal treatment. Standard of care: maximal safe resection followed by Stupp protocol (radiotherapy + temozolomide). MGMT methylation status is key prognostic marker.
Acute immune-mediated polyradiculoneuropathy causing rapidly progressive ascending weakness with areflexia. Commonest cause of acute flaccid paralysis in developed countries. Typically post-infectious. Treat with IVIg or plasma exchange. 25% require ventilation.
Spontaneous intracerebral haemorrhage (ICH) accounting for ~15% of strokes but ~50% of stroke deaths. Commonest cause is hypertension (basal ganglia, thalamus, pons, cerebellum). Mortality ~40% at 1 month. Rapid BP reduction and reversal of anticoagulation are key acute interventions.
Autosomal dominant neurodegenerative disorder caused by CAG trinucleotide repeat expansion in the HTT gene (chromosome 4). Characterised by chorea, cognitive decline, and psychiatric features. Mean onset age 35-45 years. Progressive and fatal (mean survival 15-20 years from onset). No disease-modifying treatment.
Raised intracranial pressure without hydrocephalus, mass lesion, or venous sinus thrombosis. Characteristically affects obese women of childbearing age. Presents with headache, visual disturbances, papilloedema, and pulsatile tinnitus. Untreated may cause permanent visual loss.
Acute focal neurological deficit caused by cerebral infarction due to arterial occlusion. Accounts for ~85% of strokes. Fourth leading cause of death in the UK. Time-critical treatment with thrombolysis (within 4.5 hours) and thrombectomy (within 24 hours for selected patients).
Autoimmune disorder of the presynaptic neuromuscular junction caused by antibodies against voltage-gated calcium channels (VGCC). Characterised by proximal limb weakness that improves with repeated use, depressed reflexes, and autonomic dysfunction. ~60% associated with small cell lung cancer.
Third commonest cause of dementia (~10-15%). Characterised by fluctuating cognition, recurrent visual hallucinations, parkinsonism, and REM sleep behaviour disorder. Alpha-synuclein Lewy body pathology. Extreme sensitivity to antipsychotics. Cholinesterase inhibitors are first-line treatment.
Most common benign intracranial tumour, arising from arachnoid cap cells. Usually WHO grade 1 (benign). Often incidental finding. Commoner in women and increases with age. Treatment: observation for small asymptomatic tumours; surgical resection for symptomatic or growing lesions.
Inflammation of the meninges, most commonly caused by infection (bacterial or viral). Bacterial meningitis is a medical emergency with ~20% mortality if untreated. Presents with headache, fever, neck stiffness, and photophobia. Immediate antibiotics must not be delayed.
Common primary headache disorder affecting ~15% of the UK population. Characterised by recurrent episodes of moderate-severe unilateral throbbing headache with nausea, photophobia, and phonophobia. With or without aura. Significant disability. Managed with acute and preventive therapies.
Progressive neurodegenerative disease characterised by loss of upper and lower motor neurones. Amyotrophic lateral sclerosis (ALS) is the commonest subtype. Median survival 2-5 years from symptom onset. Riluzole is the only drug shown to modestly extend survival.
Chronic autoimmune CNS demyelinating disease causing relapsing-remitting or progressive neurological disability. Commonest cause of non-traumatic neurological disability in young adults. UK prevalence ~130 per 100,000. Diagnosed by McDonald criteria (MRI dissemination in time and space).
Autoimmune disorder of the neuromuscular junction caused by antibodies against the acetylcholine receptor (AChR) or muscle-specific kinase (MuSK). Characterised by fatigable weakness affecting ocular, bulbar, and limb muscles. Associated with thymoma in ~10-15%.
Chronic neurological disorder of sleep-wake regulation caused by loss of hypocretin (orexin)-producing neurones in the hypothalamus. Type 1 features excessive daytime sleepiness and cataplexy. Type 2 has sleepiness without cataplexy. Strongly associated with HLA-DQB1*06:02. Treated with modafinil and sodium oxybate.
Autoimmune CNS inflammatory disorder distinct from MS, characterised by severe optic neuritis and longitudinally extensive transverse myelitis (≥3 vertebral segments). Caused by AQP4-IgG antibodies in ~80%. More common in non-Caucasian populations. Requires different treatment from MS.
Communicating hydrocephalus with normal or intermittently elevated CSF pressure causing the classic triad of gait disturbance, urinary incontinence, and dementia. One of the few potentially reversible causes of dementia. Diagnosed by MRI (ventriculomegaly out of proportion to atrophy) and therapeutic lumbar puncture.
Progressive neurodegenerative disorder caused by loss of dopaminergic neurones in the substantia nigra pars compacta. Cardinal features: bradykinesia, rigidity, rest tremor, postural instability. Second commonest neurodegenerative disease after Alzheimer's. Prevalence increases with age.
Damage to peripheral nerves causing sensory, motor, and/or autonomic dysfunction. Most commonly length-dependent (distal symmetric polyneuropathy). Diabetes and alcohol are the two commonest causes in the UK. Systematic investigation identifies the cause in ~75% of cases.
Elevation of intracranial pressure above normal (>20 cmH₂O / >15 mmHg) due to increased CSF, blood, brain tissue volume, or space-occupying lesion. Medical/neurosurgical emergency if acute. Presents with headache, vomiting, papilloedema, and altered consciousness.
Common sensorimotor disorder characterised by an irresistible urge to move the legs, typically worse in the evening/at rest, relieved by movement. Prevalence ~5-10%. Associated with iron deficiency, pregnancy, and chronic kidney disease. First-line treatment: correct iron deficiency; dopamine agonists or alpha-2-delta ligands.
Neurosurgical/oncological emergency. Compression of the spinal cord causing progressive weakness, sensory level, and sphincter dysfunction. Commonest cause in adults is metastatic malignancy. Urgent MRI and dexamethasone required. Outcome depends on speed of treatment.
Autosomal recessive neurodegenerative disorder caused by homozygous deletion/mutation of SMN1 gene on chromosome 5q. Leads to progressive loss of anterior horn cells and proximal muscle weakness. Commonest genetic cause of infant death. Nusinersen and gene therapy have transformed outcomes.
Continuous seizure activity lasting >5 minutes or recurrent seizures without regaining consciousness between episodes. Medical emergency with mortality 10-20%. Requires stepwise pharmacological management: benzodiazepines → IV phenytoin/levetiracetam → general anaesthesia.
Bleeding into the subarachnoid space, most commonly from a ruptured berry aneurysm (85%). Presents with sudden-onset thunderclap headache. Mortality ~50%. Diagnosed by CT head (sensitivity >95% within 6 hours) then LP if CT negative. Neurosurgical emergency.
Collection of blood between the dura and arachnoid mater, usually from tearing of bridging veins. Acute SDH follows significant trauma (mortality 50-90%). Chronic SDH is common in elderly/anticoagulated patients after minor/forgotten trauma; presents insidiously with confusion and neurological decline.
Commonest primary headache disorder. Bilateral, pressing/tightening, mild-moderate intensity headache without significant nausea, photophobia, or phonophobia. Affects up to 80% of the population. Divided into episodic and chronic forms.
Transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischaemia without acute infarction. Symptoms typically last <1 hour. High early stroke risk (up to 10% at 7 days). ABCD² score guides urgency. Immediate antiplatelet and rapid investigation essential.
Severe, paroxysmal, lancinating facial pain in the distribution of one or more divisions of the trigeminal nerve. Attacks last seconds to 2 minutes and are triggered by innocuous stimuli. First-line treatment is carbamazepine. MRI is mandatory to exclude secondary causes.
Second commonest cause of dementia (~20%), caused by cerebrovascular disease (ischaemic or haemorrhagic). Presents with stepwise cognitive decline, executive dysfunction, and gait disturbance. Vascular risk factor modification is the cornerstone of management. No specific anti-dementia drugs approved.
Vertigo is an illusion of rotational movement. Most commonly caused by benign paroxysmal positional vertigo (BPPV), vestibular neuritis, or Ménière disease. Central causes (stroke, MS) must be excluded. BPPV is treated with Epley manoeuvre. HINTS test distinguishes peripheral from central causes.