Neurology

Alzheimer's Disease & Dementia
Dementia is a clinical syndrome characterized by impairment of multiple higher cortical functions that include memory, orientation, thinking, comprehension, calculation, capacity for learning, language, judgment,  executive function and visuo-spatial function. It is usually accompanied or preceded by deterioration in emotional control, social behavior or motivation.
Alzheimer's disease is the most common cause of dementia. Sporadic cases usually present after >60 year while familial types are rare and present in <60 year of age (early-onset dementia).
Short-term memory loss is the most common early symptom. Other spheres of cognitive impairment manifest after several years.
Amyotrophic Lateral Sclerosis
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with undetermined etiology that primarily involves the motor neurons in the cerebral cortex, brainstem and spinal cord.
There is no cure and the mean duration of survival is 2-5 years without tracheostomy and ventilator support.
Clinical hallmarks of ALS are: presence of upper & lower motor neuron features involving the brainstem and spinal cord and progressive limb weakness, respiratory insufficiency, spasticity, hyperreflexia, and bulbar symptoms such as dysarthria and dysphagia.
Epilepsy
Epilepsy is a clinical multiaxial diagnosis.
Epileptic seizure is a transient occurrence of signs/symptoms brought about by abnormal excessive or synchronous neuronal activity in the brain.
It is recommended that all patients having a first seizure be referred as soon as possible to a specialist to ensure accurate and early diagnosis and initiation of treatment appropriate to the needs of the patients.
Headache
Headache is a very common problem presenting to primary care physicians and neurologists.
Most headaches are diagnosed based on the history & physical exam w/ no imaging or laboratory examination necessary.
Other types of headaches such as secondary headaches may require further evaluation & referral to a specialist.
Intracerebral Hemorrhage
Intracerebral hemorrhage is the sudden burst of blood into the brain tissue itself.
It causes sudden onset of focal neurological deficit.
The focal neurologic findings are related to the anatomic location, size and speed of development of intracerebral hemorrhage.
Neurological deficit usually progresses over a minute to an hour.
Rapid recognition and diagnosis of intracerebral hemorrhage are essential because of its frequently rapid progression.
Ischemic Stroke
Ischemic stroke occurs when a blood vessel supplying the brain is obstructed.
Consider stroke in any patient presenting with sudden focal neurological deficit or any alteration in level of consciousness.
Rapid evaluation is essential for sure of time-sensitive treatments.
Determine if patient's symptoms are due to stroke and exclude stroke mimics (eg migraine, hypertensive encephalopathy, hypoglycemia, seizures or post-ictal paresis); identify other conditions requiring immediate intervention and determine the potential causes of stroke.
Meningitis - Acute, Bacterial

Acute meningitis is the infection of the subarachnoid space and cerebrospinal fluid by bacteria that may cause local and systemic inflammatory response.
There is the classic triad of symptoms of fever, neck stiffness and altered level of consciousness.
Other symptoms include chills, myalgia, photophobia, severe headache, focal neurologic symptoms, nausea, vomiting, seizures and some patients may present with rash.

 

Migraine Headache
Migraine headache without aura has at least 5 attacks of any 2 symptoms of unilateral headache that is throbbing or pulsating in nature, moderate to severe in pain and activity aggravates pain. It is accompanied with either nausea and vomiting or photophobia &/or phonophobia. The symptoms last for 4-72 hours without signs of secondary headache.
Migraine headache with aura has at least 2 attacks with any of the fully reversible symptoms of flickering lights, spots or lines &/or vision loss, sensory symptoms of pins & needles &/or numbness and dysphasic speech disturbance but without motor weakness. Accompanied by at least 2 of the following symptoms of homonymous visual symptoms &/or unilateral sensory symptoms or at least 1 aura symptoms develop gradually over ≥5 minutes &/or different aura symptoms that occur in succession over ≥5 minutes.
Multiple Sclerosis
Multiple sclerosis is an acquired chronic immune-mediated inflammatory disease of the brain and the spinal cord characterized by presence of multiple discrete areas of myelin loss within the CNS and subsequent axonal degeneration.
Affects more women than man; however, men are more likely to have a malignant clinical course.
A multiple sclerosis attack is usually characterized by any neurological disturbance with minimum 24 hours duration, in the absence of fever or infection.
Myasthenia Gravis
Myasthenia gravis is an autoimmune neurological disorder caused by autoantibodies against the acetylcholine receptor or against a receptor-associated protein, muscle-specific tyrosine kinase (MuSK-Ab).
The autoimmune attack at the muscle endplate leads to failure of neuromuscular transmission and eventually muscle weakness.
In the active phase of the disease, symptoms typically fluctuates and then become severe; myasthenic crisis occur in this phase.
In the stable/inactive phase, symptoms are stable but still persist; it usually worsen attributable to infection, fatigue, tapering of medications or other identifiable factors.
In the burnt-out phase, remission may occur wherein patients are on immunotherapy and symptom-free, or may even be off medications.
In 15-20 years, if the symptoms left untreated, patient's weakness becomes fixed wherein the most severely affected muscles become atrophic.
Narcolepsy

Narcolepsy is a chronic neurologic sleep disorder wherein the patient have excessive daytime sleepiness and rapid eye movement sleep is dysregulated.

It affects 1 in 1000 individuals, with prevalence of about 0.04% of general population.
The exact cause remains unclear.
Studies suggest a combination of genetic predisposition, abnormal neurotransmitter functioning and abnormal immune modulation.
Symptoms include excessive daytime sleepiness, cataplexy, sleep paralysis, sleep-related hallucinations, automatic behavior, fragmented nocturnal sleep and insomnia.

Neuropathic Pain
Neuropathic pain is the sensation of pain due to abnormal discharges of impaired or injured neural structures in the peripheral &/or central nervous system.
It is characterized by hyperesthesia, hyperalgesia and allodynia.
Common neuropathic pain syndromes are central neuropathic pain, painful diabetic peripheral neuropathy, postherpetic neuralgia, trigeminal neuralgia, postsurgical neuropathic pain, HIV-related neuropathy, lumbosacral radiculopathy and complex regional pain syndrome.
Parkinson's Disease & Parkinson's Disease Dementia

Parkinson's disease is a progressive neurodegenerative disorder that is common, age-related and chronic.

It is caused by loss or degeneration of dopaminergic neurons in the substantia nigra of the midbrain.

Onset of symptoms and progression of the disease is gradual.

Motor signs and symptoms include resting tremor, rigidity, bradykinesia and postural instability.

Parkinson's disease dementia indicates loss of intellectual functions including memory, significant deterioration in the ability to carry out day-to-day activities and changes in social behavior are often noted.

Tourette's Syndrome & Other Tic Disorders
Tics are sudden, rapid, non-rhytmic, repetitive, motor movements or vocalizations. The mean age of onset is approximately 5 years old.
Tourette's syndrome is the most common form of tic disorder.
There is a strong genetic component showing a 10- to 100-fold increase in the rates of tics and Tourette's syndrome among first-degree relatives of Tourette's syndrome patients.
Simple motor tics are restricted to a single or a few muscle groups and last less than a fraction of a second.
Complex motor tics involve larger muscle groups, usually last longer and appear purposeful and goal-directed.
Vertigo

Vertigo is having a sensation of spinning of either the surrounding or within oneself but physical movement does not exist.

It may be secondary to different causes that may be determined by numerous factors eg timing and duration, aggravating conditions or associated symptoms.
Central vertigo originates from the central nervous system (brainstem or cerebellum). It is uncommon but more serious and should be ruled out immediately.
Peripheral vertigo originates from the labyrinth or vestibular nerve.