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Top100 Diseases

 neurological diseases

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Cerebrovascular disease
This is the third most common cause of death in the UK. Stroke is the common acute outcome of this disease, but the disease can also cause a chronic multiinfarct dementia. The incidence of stroke in the general population is 2 per 1000 per year, but it is actually much more common than this in the elderly.

What to learn
  • Classification and causes of cerebrovascular events.
  • Clinical features of stroke and how they relate to the site of the lesion.
  • Acute management of the stroke patient.
  • Rehabilitation and prevention.

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Seizures are common in that 3% of the population have two or more seizures during their lives. An epileptic seizure is a convulsion or transient abnormal event that occurs due to the paroxysmal discharge of neurons. By definition, epilepsy is the continuing tendency to have such seizures.

What to learn
  • Classification of epilepsy and prognostic features: criteria for diagnosis.
  • Risk factors and causes of epilepsy: factors that might precipitate a seizure.
  • Emergency management of status epilepticus.
  • Long-term medical management with anticonvulsants.

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Defined as inflammation of the meninges, this disease can be caused by bacterial, viral or, less commonly, fungal and protozoal infections. Bacterial meningitis is common and potentially life threatening if not diagnosed and treated promptly.

What to learn
  • Causative organisms of meningitis.
  • Clinical features of bacterial meningitis and diagnosis.
  • Emergency management of bacterial meningitis and prophylaxis for contacts.
  • Long-term complications.

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Head injury
This is a common cause of acute admission to the hospital. Approximately 200 to 300 patients admitted per 100,000 per year have head injuries, and of these, roughly 5% die from the injury. Many more suffer long-term disability as a result.

What to learn
  • Causes and classification of head injury: skull fracture, rupture of meningeal artery or dural veins.
  • Mechanisms of brain damage: direct neuronal damage, raised intracranial pressure, oedema, ischaemia and hypoxia.
  • Clinical features, diagnosis and management.
  • Late sequelae of head injury.

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Headaches are very common causes of presentation. Headaches are commonly benign but can occasionally indicate a serious underlying condition. A detailed history is essential in deciding whether to reassure the patient or investigate further.

What to learn
  • Causes and classification of headache.
  • What to look for in the history that could signify a serious cause.
  • Acute management and prophylaxis of migraine headache.
  • Diagnostic features of subarachnoid hemorrhage

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Chronic pain
Chronic pain is a common presentation in primary care. It is a difficult problem to manage, and finding a diagnosis can be a long process. Although chronic pain is not a common exam topic, you will frequently have to deal with patients who have it.

What to learn
  • Common causes and risk factors for chronic pain.
  • Psychological and social factors that might exacerbate chronic pain.
  • Management options for chronic pain: medical, surgical, psychological, and social; don't go into a lot of detail but ensure that you know what is available.

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Parkinson's disease
Parkinson’s disease is a degenerative disease of dopaminergic neurons in the substantia nigra, which causes an akinetic-rigid syndrome. It is characterized by resting tremor, slow voluntary movement, and rigidity. Prevalence is 1 in 1000 of all adults, but rises to 1 in 200 in adults over 65 years of age.

What to learn
  • Underlying mechanisms of the disease; in addition, learn about other causes for the parkinsonian syndrome (as opposed to the disease).
  • Symptoms, signs and diagnosis.
  • Medical management of Parkinson's disease and side-effects of primary treatment.

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Alzheimer's disease
Alzheimer’s disease, a degenerative disease of the cortex, is the most common cause of dementia in Western countries. In the UK it affects 5% of people over 65 years of age, and 15% over the age of 80. Etiology and pathogenesis are not fully understood, but characteristic histological changes and atrophy of the frontal lobes occur in patients with Alzheimer’s disease.

What to learn
  • Characteristic histological features: senile plaques, neurofibrillary tangles, and neuropil threads.
  • New genetic studies: ApoEe4 genotype on chromosome 19 (often found in patients with Alzheimer’s disease).
  • Clinical features of dementia.
  • How to perform a mental state examination.
  • Prognosis and long-term management of Alzheimer's disease.

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Multiple sclerosis (MS)
Multiple sclerosis is the most common demyelinating disorder of the central nervous system (CNS). It affects 50 per 100,000 in the UK, and peak incidence occurs between 20 and 40 years of age. MS is characterized by relapsing and remitting episodes of immunologically mediated demyelination in the CNS.

What to learn
  • Current theories on etiology and pathogenesis: association with human leukocyte antigen (HLA).
  • Clinical features of MS.
  • Diagnostic tests: computerized tomography (CT) and magnetic resonance imaging (MRI); cerebrospinal fluid (CSF) examination for lymphocytes and oligoclonal bands.
  • Medical management of MS.

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Motor neuron disease
Motor neuron disease is a progressive degenerative condition of motor neurons in the spinal cord, and of the somatic motor nuclei of the cranial nerves and the cortex. The prevalence in the UK is about 6 in 100,000, with onset mainly in the middle years of life. The cause is unknown.

What to learn
  • The three main patterns: progressive muscular atrophy, amyotrophic lateral sclerosis (ALS) and progressive bulbar palsy.
  • Clinical features of the three types of motor neuron disease.
  • Diagnosis: no specific tests exist; diagnosis is made on clinical grounds alone.
  • Management options.

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