Neurology

DDDDDDDDDDDD Effective management logically follows accurate diagnosis. Such logic often is difficult to apply in practice. Absolute diagnostic accuracy may not be possible, particularly in the field of primary care, when management has to be on analysis of symptoms and on knowledge of the individual patient and family. This series follows that on Problems in Practice which was con­ cerned more with diagnosis in the widest sense and this series deals more definitively with general care and specific treatment of symp­ toms and diseases. Good management must include knowledge of the nature, course and outcome of the conditions, as well as prominent clinical features and assessment and investigations, but the emphasis is on what to do best for the patient. Family medical practitioners have particular difficulties and advantages in their work. Because they often work in professional isolation in the community and deal with relatively small numbers of near-normal patients their experience with the more serious and more rare conditions is restricted. They find it difficult to remain up-to-date with medical advances and even more difficult to decide on the suitability and application of new and relatively untried methods compared with those that are 'old' and well proven. IX Their advantages are that because of long-term continuous care for their patients they have come to know them and their families well and are able to become familiar with the more common and less serious diseases of their communities.

1. Introduction.- The history: the GPs role: drugs prescribed, allergies A brief neurological examination: special aspects vision, pupils, nystagmus.- Specialised neurological investigations in hospital. Indications for hospital admission.- 2. Headache.- History. Recurrent headaches—migraine, management. Acute headache — infective, haemorrhagic, raised intracranial pressure, arteritis.- Chronic headache, depression, tension. Subdural haematoma. Others.- 3. Loss of Consciousness.- Vascular: syncope — cough, micturition, carotid sinus.- Cardiac causes.- Migraine. Transient global amnesia. Epilepsy. Types of fit, major, petit mal. Partial seizures.- Causes, investigations. Treatment. Driving. Employment. Duration of treatment.- Status epilepticus. Febrile convulsions. Childhood seizures.- Rare causes — breath-holding, narcolepsy, metabolic. Non-epileptic seizures (hysterical).- 4. Giddiness.- Nystagmus. Acute vestibular and labyrinthine failure.- Positional vertigo. Ménière’s disease. Central vertigo — multiple sclerosis, vascular disease.- Chronic ataxia — cerebellar signs, cerebellopontine angle tumours.- Progressive unsteadiness.- 5. Facial Pain.- Acute — dental, sinusitis, ocular, trauma. Recurrent — migrainous neuralgia and migrainous variants. Trigeminal neuralgia.- Chronic — compressive causes, post-herpetic neuralgia, temporo-mandibular joint dysfunction, atypical facial pain.- Bell’s palsy.- 6. Visual Disturbances.- Acute visual failure — optic neuritis, ischaemic papillitis.- Transient visual loss. Compression — optic nerve and chiasm.- Retro-chiasmal pathways. Chronic visual loss — ocular, compressive, toxic, inherited.- Double vision. Assessment. Ocular motor palsies.- Dysthyroid eye disease. Myasthenia gravis. Conjugate gaze problems, internuclear ophthalmoplegia, supranuclear palsies. Ocular myopathies.- Proptosis with ophthalmoplegia.- 7. Failing Memory.- Assessment. Dysphasia. Parietal and frontal lesions.- Brain failure: causes — senile and Alzheimer’s dementia, multi-infarct dementia, normal pressure hydrocephalus.- Search for causes; investigations; management.- 8. Cerebrovascular Disease.- Strokes — pathogenesis, outcome, presentation. Subarachnoid haemorrhage. Treatment-home or hospital? Psychological upsets.- Transient ischaemic attacks — management. Stroke risk factors, prevention.- 9. Back and Limb Pain, Weakness.- Back pain.- Painful weak arm — Cervical disc, spondylosis. Brachial plexus.- Peripheral nerve — carpal tunnel, ulnar nerve lesion.- Painful weak leg — disc prolapse. Foot drop. Sphincter upsets.- Diabetic amyotrophy. Meralgia paraesthetica. Lateral popliteal palsy.- General weakness — polyneuropathy, acute (Guil-lain-Barré). Chronic-diabetic, heredofamilial, others. Muscle disorders — dystrophies, polymyositis, polymyalgia rheumatica.- Myasthenia gravis.- 10. Gait Disorders.- Causes.- Children — spastic and flaccid weakness, clumsy and unsteady.- Adults — spastic and flaccid weakness. Spinal cord infarction.- Syringomyelia. Sub-acute combined degeneration.- Motor neurone disease.- Spinal cord compression. Falls in the elderly.- 11. Involuntary Movements.- Tremor, tics, chorea, dystonia. Spasmodic torticollis, writer’s cramp, oro-mandibular dystonia. Hemifacial spasm. Restless legs.- 12. Multiple Sclerosis.- Presentation. In new patients, investigations, treatment. When to tell. The chronic patient — sphincter problems, spasticity, skin care, aids, questions.- 13. Parkinson’s Disease.- Presentation. Prognosis. Treatment. Problems and failure of treatment.- 14. The Unconscious Patient, Head Injuries.- Assessment, immediate measures. Causes. Management.- Head injuries: assessment, when to admit? Extradural haematoma.- Residual sequelae. Post-traumatic epilepsy. Post-concussive states.- 15. Spinal Cord Injuries.- Incidence. First aid management and transport. Long term sequelae, rehabilitation. Resources available. Aids at home.- References.- Proprietary Drug Names.