NEUROLOGICAL DISORDERS

Assessment of Neurological Functions

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1. History Taking (Subjective Assessment):

• Chief Complaint (CC):
  Identify primary symptoms—headache, dizziness, seizures, numbness, weakness, visual or speech disturbances.
• History of Present Illness (HPI):
  Onset (sudden/gradual), duration, progression, aggravating/relieving factors, associated symptoms.
• Past Medical History:
  Stroke, epilepsy, head trauma, infections (meningitis, encephalitis), metabolic disorders (diabetes, hypertension).
• Family History:
  Genetic conditions like Huntington’s disease, Alzheimer’s, epilepsy, migraines.
• Medication History:
  Use of anticoagulants, neurotoxic drugs, recent vaccinations, substance abuse.
• Social History:
  Alcohol/drug use, occupational hazards (exposure to toxins), stress factors.
• Functional Status:
  Changes in daily activities, memory, behavior, or mood.

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2. Physical Examination (Objective Assessment):

• Level of Consciousness (LOC):
  • Glasgow Coma Scale (GCS): Eye Opening (4), Verbal Response (5), Motor Response (6)
  • AVPU Scale (Alert, responds to Voice, Pain, Unresponsive)
• Cranial Nerve Examination (I–XII):
  • CN I (Olfactory): Smell test
  • CN II (Optic): Visual acuity, fields, fundoscopy
  • CN III, IV, VI: Pupil response, eye movements
  • CN V: Facial sensation, jaw strength
  • CN VII: Facial symmetry, expressions
  • CN VIII: Hearing (Rinne, Weber tests), balance
  • CN IX, X: Gag reflex, swallowing, voice
  • CN XI: Shoulder shrug, head turn
  • CN XII: Tongue movement
• Motor System:
  • Muscle Strength: Graded 0–5 (Medical Research Council scale)
  • Tone: Spasticity, rigidity, flaccidity
  • Coordination: Finger-to-nose, heel-to-shin, rapid alternating movements
• Sensory System:
  • Light touch, pain, temperature, vibration (using tuning fork), proprioception
  • Compare bilaterally for symmetry
• Reflexes:
  • Deep Tendon Reflexes (DTRs): Biceps, triceps, patellar, Achilles (graded 0–4+)
  • Pathological Reflexes: Babinski sign (positive = dorsiflexion of big toe)
• Gait & Balance:
  • Romberg’s test, tandem walking, observation of base, stride, and posture
• Meningeal Signs:
  • Kernig’s sign: Pain on knee extension with hip flexed
  • Brudzinski’s sign: Neck flexion causes hip/knee flexion

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3. Diagnostic Evaluation:

• Neuroimaging:
  • CT Scan (Non-contrast): For stroke, hemorrhage, trauma
  • MRI: Detailed imaging of brain/spinal cord (tumors, MS, ischemia)
  • MRA/CTA: Vascular abnormalities like aneurysms, AV malformations
• Electrophysiological Tests:
  • EEG (Electroencephalogram): Seizure activity, encephalopathy
  • EMG (Electromyography) & Nerve Conduction Studies: Neuromuscular disorders
• Lumbar Puncture (CSF Analysis):
  • Indications: Suspected meningitis, encephalitis, subarachnoid hemorrhage, MS
  • Measure: Opening pressure, cell counts, glucose, protein, cultures
• Blood Tests:
  • CBC, electrolytes, blood glucose, infection markers, toxins, autoimmune panels
• Other Tests:
  • Carotid Doppler Ultrasound: For carotid artery stenosis
  • Cerebral Angiography: Gold standard for vascular assessment
  • Evoked Potentials: For visual, auditory, and somatosensory pathway evaluation

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Key Points for Competitive Exams:

1. GCS < 8 = Coma (Intubation needed)
2. Babinski Sign: Indicates upper motor neuron lesion
3. CT (without contrast) is first-line in acute stroke
4. EEG is the gold standard for epilepsy diagnosis
5. Brudzinski’s and Kernig’s signs are positive in meningitis
6. MRI is more sensitive than CT for detecting early ischemic stroke
7. Romberg’s positive = sensory ataxia (proprioception issue)
8. Carotid bruit = risk for ischemic stroke
9. CSF opening pressure > 20 cm H₂O = raised intracranial pressure
10. Decorticate (flexor) vs. Decerebrate (extensor) posturing indicates severity of brain injury

1. Increased Intracranial Pressure (ICP)

Definition:

ICP is the pressure within the skull, normally ranging from 5-15 mmHg. ICP > 20 mmHg is considered elevated and requires immediate attention.

Causes:

• Traumatic Brain Injury (TBI)
• Stroke (ischemic or hemorrhagic)
• Brain Tumors
• Infections: Meningitis, Encephalitis
• Hydrocephalus
• Cerebral Edema
• Subarachnoid Hemorrhage

Signs & Symptoms (Cushing’s Triad – Late Sign):

• Hypertension (with widened pulse pressure)
• Bradycardia
• Irregular Respirations (Cheyne-Stokes breathing)

Other Symptoms:

• Headache
• Vomiting (projectile, without nausea)
• Decreased LOC
• Papilledema (optic disc swelling)
• Blurred or double vision
• Seizures

Assessment Tools:

• Glasgow Coma Scale (GCS): Score < 8 = Severe injury
• Pupil Assessment: Dilated, non-reactive pupils suggest brain herniation
• Vital Signs Monitoring

Management:

• Position: Head elevated at 30° to promote venous drainage
• Airway and Breathing: Intubation if needed
• Osmotic Therapy: Mannitol, Hypertonic saline
• Sedation: To reduce metabolic demand
• Drainage of CSF: Via external ventricular drain
• Avoid: Hypotension, hypoxia, hypercapnia
• Surgery: Decompressive craniectomy if refractory ICP

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2. Intracranial Surgery

Types of Intracranial Surgeries:

• Craniotomy: Opening of the skull to remove a tumor, blood clot, or relieve pressure
• Craniectomy: Part of the skull is removed without replacing the bone flap immediately
• Burr Hole: Small holes drilled to relieve pressure or drain hematomas
• Shunt Placement: To treat hydrocephalus

Indications:

• Brain tumors
• Traumatic brain injury
• Aneurysms and AV malformations
• Intracranial hemorrhage
• Hydrocephalus
• Infections (abscess drainage)

Preoperative Care:

• Baseline neurological assessment
• Imaging studies (CT, MRI)
• Blood tests (coagulation profile)
• Educate the patient and family
• NPO (nothing by mouth) status

Postoperative Complications to Monitor:

• Increased ICP (most common)
• Infection: Meningitis, abscess
• CSF Leak: Clear fluid from nose/ears
• Seizures: Due to irritation of brain tissue
• Hematoma: Epidural or subdural
• Hydrocephalus: Requires shunt placement

Postoperative Nursing Care:

• Monitor GCS, pupil size/reactivity, limb strength
• Head elevation (30°) unless contraindicated
• Avoid hip flexion, neck rotation to prevent ICP rise
• Strict I&O monitoring for fluid balance
• Seizure precautions
• Monitor for signs of CSF leak (halo sign on dressing)
• Administer steroids (to reduce edema) and anticonvulsants

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Key Points for Competitive Exams:

1. Normal ICP = 5-15 mmHg; Elevated ICP > 20 mmHg
2. Cushing’s Triad = Late sign of ICP (HTN, bradycardia, irregular breathing)
3. GCS ≤ 8 = Severe neurological impairment (needs airway protection)
4. Mannitol = First-line drug to reduce ICP (osmotic diuretic)
5. CSF Leak Test = Halo sign (clear ring around blood on gauze)
6. Decorticate Posturing = Damage to cerebral hemispheres; Decerebrate = Brainstem injury
7. Papilledema = Swelling of optic disc, sign of increased ICP
8. Avoid lumbar puncture in raised ICP to prevent brain herniation
9. Hyperventilation temporarily reduces ICP by lowering PaCO₂
10. Post-craniotomy care = Monitor for ICP, infection, seizures, and CSF leakage.

1. Headache

Types:

• Primary Headaches:
  • Migraine
  • Tension-type headache
  • Cluster headache
• Secondary Headaches:
  Due to underlying conditions (e.g., infections, brain tumors, vascular disorders, trauma).

Red Flag Symptoms (Serious Underlying Cause):

• Sudden, severe headache (“thunderclap headache”)
• Neck stiffness, fever (meningitis, subarachnoid hemorrhage)
• Neurological deficits
• Vision changes
• Altered mental status

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2. Migraine

Definition:

A recurrent, throbbing headache often accompanied by nausea, vomiting, and sensitivity to light and sound.

Types:

• Migraine with Aura: Visual or sensory disturbances before headache onset.
• Migraine without Aura: Most common type.

Triggers:

Stress, hormonal changes, lack of sleep, certain foods (cheese, chocolate), bright lights.

Phases:

1. Prodrome: Mood changes, food cravings
2. Aura: Visual disturbances (flashing lights, blind spots)
3. Headache: Throbbing pain, unilateral, worsens with activity
4. Postdrome: Fatigue, confusion

Management:

• Acute Attack: NSAIDs, Triptans (Sumatriptan), antiemetics
• Prophylaxis: Beta-blockers (propranolol), antiepileptics (topiramate), tricyclic antidepressants

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3. Seizures

Definition:

A sudden, uncontrolled electrical disturbance in the brain causing changes in behavior, movements, sensations, or consciousness.

Types:

• Focal (Partial) Seizures:
  • Simple Focal: No loss of consciousness
  • Complex Focal: Impaired consciousness
• Generalized Seizures:
  • Tonic-clonic (Grand Mal): Stiffening (tonic) followed by jerking (clonic)
  • Absence (Petit Mal): Brief loss of awareness
  • Myoclonic: Sudden, brief jerks
  • Atonic: Sudden loss of muscle tone (“drop attacks”)

Causes:

Brain injury, infections, metabolic disturbances, fever (in children), epilepsy, tumors.

Management:

• During Seizure: Protect airway, prevent injury, do not restrain, do not put objects in the mouth.
• After Seizure (Postictal Phase): Recovery position, monitor breathing.

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4. Epilepsy

Definition:

A chronic neurological disorder characterized by recurrent, unprovoked seizures.

Diagnosis:

• EEG: Detects abnormal brain activity
• Neuroimaging: MRI/CT to identify structural abnormalities

Management:

• Medications: Antiepileptic drugs (AEDs) like phenytoin, carbamazepine, valproic acid, levetiracetam
• Surgical Treatment: For drug-resistant epilepsy (e.g., temporal lobectomy)
• Lifestyle Modifications: Avoid triggers, adequate sleep, stress reduction

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5. Status Epilepticus (SE)

Definition:

A medical emergency where a seizure lasts >5 minutes or recurrent seizures occur without regaining consciousness between episodes.

Types:

• Convulsive SE: Prolonged tonic-clonic seizures
• Non-convulsive SE: Subtle or absent motor signs, altered mental status

Causes:

Non-adherence to AEDs, stroke, CNS infections, metabolic imbalances.

Management (ABCDE Approach):

1. Airway, Breathing, Circulation: Oxygen, secure airway if needed
2. Benzodiazepines: Lorazepam (first-line), diazepam
3. Antiepileptics: Phenytoin, valproic acid
4. Refractory SE: May require anesthesia (propofol, midazolam infusion)
5. Identify and treat underlying cause

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6. Cerebrovascular Accident (CVA) – Stroke

Definition:

A sudden loss of brain function due to disruption in blood supply.

Types:

• Ischemic Stroke (85%):
  • Thrombotic: Clot forms in a brain artery
  • Embolic: Clot travels from another part of the body (often heart)
• Hemorrhagic Stroke (15%):
  • Intracerebral Hemorrhage: Bleeding within the brain
  • Subarachnoid Hemorrhage: Bleeding into the space around the brain

Risk Factors:

Hypertension, atrial fibrillation, diabetes, smoking, high cholesterol.

Signs and Symptoms (FAST):

• F: Facial drooping
• A: Arm weakness
• S: Speech difficulty
• T: Time to call emergency services

Diagnosis:

• CT Scan (Non-contrast): To differentiate ischemic from hemorrhagic stroke
• MRI: More sensitive for early ischemic changes
• Carotid Doppler, Echocardiography: Identify source of emboli

Management:

• Ischemic Stroke:
  • Thrombolysis (tPA): If within 4.5 hours of symptom onset
  • Antiplatelets: Aspirin
  • Control BP, glucose
• Hemorrhagic Stroke:
  • Blood pressure control
  • Surgery: For large hematomas or aneurysms

Complications:

Paralysis, speech impairment, memory loss, depression, recurrent stroke.

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Key Points for Competitive Exams:

1. Migraine = Unilateral throbbing pain with/without aura
2. Cushing’s Triad = Late sign of raised ICP in CVA (HTN, bradycardia, irregular breathing)
3. Seizure > 5 mins = Status Epilepticus (medical emergency)
4. EEG = Gold standard for epilepsy diagnosis
5. tPA = Given within 4.5 hours for ischemic stroke
6. FAST = Early stroke recognition mnemonic
7. Phenytoin toxicity signs = Nystagmus, ataxia, confusion
8. Febrile seizures = Common in children, usually benign
9. Ischemic stroke is more common than hemorrhagic stroke (85% vs 15%)
10. Lorazepam = First-line drug for status epilepticus.

1. Head Trauma

Definition:

Any injury to the scalp, skull, or brain due to external mechanical force.

Types:

• Closed (Blunt) Head Injury: Skull remains intact
• Open (Penetrating) Head Injury: Skull is fractured, dura mater breached

Clinical Features:

• Loss of consciousness
• Headache, vomiting
• Confusion, drowsiness
• Seizures
• Bleeding from ears, nose (raccoon eyes, Battle’s sign)
• CSF leak (halo sign)

Assessment:

• Glasgow Coma Scale (GCS): To assess consciousness
• Pupil size and reaction: Unequal pupils = brain herniation
• Vital signs: Check for signs of raised intracranial pressure (Cushing’s triad)

Imaging:

• Non-contrast CT scan: First-line imaging to detect bleeding, fractures, brain swelling
• MRI: For detailed soft tissue injury

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2. Brain Trauma (Traumatic Brain Injury – TBI)

Types of TBI:

• Concussion: Temporary loss of brain function; confusion, headache, brief LOC
• Contusion: Bruising of brain tissue; focal neurological signs
• Diffuse Axonal Injury: Widespread damage to white matter; leads to coma
• Hematomas: Subdural and epidural (extradural) hematomas

Pathophysiology:

Primary injury (at impact) leads to secondary injury due to inflammation, ischemia, and increased ICP.

Management:

• Airway, Breathing, Circulation (ABC) stabilization
• Control ICP: Head elevation, mannitol, hypertonic saline
• Surgical intervention: For hematomas or brain swelling
• Seizure prophylaxis: In high-risk patients

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3. Spinal Cord Trauma

Causes:

• Motor vehicle accidents
• Falls
• Sports injuries
• Violence (gunshot, stabbing)

Types of Spinal Cord Injury:

• Complete Injury: Total loss of motor and sensory function below the injury
• Incomplete Injury: Some function preserved

Clinical Features:

• Paralysis or weakness (paraplegia, quadriplegia)
• Loss of sensation
• Loss of bladder/bowel control
• Spinal shock (temporary loss of reflexes below injury)

Assessment:

• Neurological exam: Motor, sensory, reflexes
• Imaging: X-ray, CT, MRI for spinal cord assessment

Management:

• Immobilization: To prevent further damage
• High-dose steroids (controversial): May reduce inflammation
• Surgery: For decompression or stabilization
• Rehabilitation: Long-term physical therapy

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4. Subdural Hematoma (SDH)

Definition:

Bleeding between the dura mater and arachnoid mater.

Causes:

• Head injury (especially in elderly or alcoholics)
• Anticoagulant therapy
• Shaken baby syndrome

Types:

• Acute SDH: Symptoms within 24-48 hours
• Subacute SDH: Symptoms in 2-14 days
• Chronic SDH: Develops over weeks to months

Symptoms:

• Gradual loss of consciousness
• Headache
• Confusion, personality changes
• Focal neurological deficits (weakness, speech problems)

Diagnosis:

• CT Scan: Crescent-shaped hyperdense lesion
• MRI: Better for chronic SDH

Treatment:

• Small SDH: Observation if stable
• Large SDH: Surgical evacuation (burr hole or craniotomy)

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5. Extradural (Epidural) Hematoma (EDH)

Definition:

Bleeding between the dura mater and skull.

Cause:

• Arterial bleed (commonly middle meningeal artery) due to skull fracture

Classic Presentation (Lucid Interval):

1. Initial loss of consciousness
2. Lucid interval (temporary recovery)
3. Rapid deterioration (due to increasing ICP)

Symptoms:

• Severe headache
• Vomiting
• Seizures
• Ipsilateral dilated pupil (due to CN III compression)
• Contralateral hemiparesis

Diagnosis:

• CT Scan: Lens-shaped (biconvex) hyperdense lesion

Management:

• Emergency craniotomy to evacuate the hematoma
• ICP control: Mannitol, hyperventilation, head elevation

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Key Differences: SDH vs. EDH

Feature	Subdural Hematoma (SDH)	Epidural Hematoma (EDH)
Location	Between dura and arachnoid	Between dura and skull
Bleeding Source	Venous (bridging veins)	Arterial (middle meningeal artery)
CT Appearance	Crescent-shaped	Lens-shaped (biconvex)
Onset	Gradual (hours to weeks)	Rapid (minutes to hours)
Age Group Affected	Elderly, alcoholics	Young adults with trauma
Lucid Interval	Rare	Common

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General Management Principles for Neurological Trauma

1. Primary Survey (ABCDE):
   • Airway: Protect cervical spine
   • Breathing: Oxygenation
   • Circulation: Control bleeding, maintain BP
2. Secondary Survey:
   • Detailed neurological exam
   • GCS assessment
   • Pupil size/reactivity
3. ICP Management:
   • Head elevation (30°)
   • Mannitol, hypertonic saline
   • Sedation and mechanical ventilation if needed
4. Definitive Treatment:
   • Surgical decompression (if needed)
   • Long-term rehabilitation

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Key Points for Competitive Exams

1. GCS ≤ 8 = Severe brain injury (needs airway protection)
2. Cushing’s Triad (HTN, bradycardia, irregular respirations) = Raised ICP
3. Lucid Interval = Characteristic of Epidural Hematoma
4. CT = First-line imaging for head injury
5. Spinal cord injuries require immediate immobilization
6. SDH = Crescent-shaped bleed; EDH = Lens-shaped bleed on CT
7. Decorticate vs. Decerebrate posturing = Indicates severity of brain injury
8. Mannitol = First-line drug for reducing ICP
9. Pupillary changes (unequal pupils) suggest brain herniation
10. High-dose steroids are controversial in spinal cord injury management

1. Meningitis

Definition:

Inflammation of the meninges (protective membranes covering the brain and spinal cord).

Types:

• Bacterial Meningitis (Medical Emergency):
  • Common Causes: Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae
• Viral Meningitis: Less severe; caused by enteroviruses, HSV, HIV
• Fungal Meningitis: Seen in immunocompromised (e.g., Cryptococcus in HIV)
• Tubercular Meningitis: Common in developing countries

Clinical Features:

• Classic Triad:
  • Fever
  • Neck stiffness
  • Altered mental status
• Other Symptoms:
  • Severe headache
  • Photophobia
  • Nausea, vomiting
  • Seizures
  • Positive Kernig’s sign and Brudzinski’s sign

Complications:

• Seizures
• Hearing loss
• Hydrocephalus
• Brain herniation (if untreated)

Diagnosis:

• Lumbar Puncture (CSF Analysis):
  • Bacterial Meningitis: ↑WBC (neutrophils), ↓glucose, ↑protein
  • Viral Meningitis: ↑lymphocytes, normal glucose, slightly ↑protein
• CT Scan: Before LP if signs of increased ICP
• Blood Cultures

Management:

• Empiric Antibiotics (immediately):
  • Ceftriaxone + Vancomycin
  • Ampicillin (if Listeria suspected in elderly/immunocompromised)
• Steroids (Dexamethasone): Reduces inflammation
• Supportive Care: Fluids, oxygen, seizure management

Prevention:

• Vaccination: Hib, Pneumococcal, Meningococcal vaccines
• Prophylaxis for contacts: Rifampin (for N. meningitidis)

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2. Brain Abscess

Definition:

A localized collection of pus within the brain parenchyma due to infection.

Causes:

• Direct Spread: Sinusitis, otitis media, dental infections
• Hematogenous Spread: Endocarditis, lung infections
• Post-surgical or traumatic injuries

Common Pathogens:

• Streptococcus spp., Staphylococcus aureus, anaerobes
• Fungal abscesses in immunocompromised patients

Clinical Features:

• Classic Triad (only in ~50%):
  • Headache (most common symptom)
  • Fever
  • Focal neurological deficits
• Other Symptoms:
  • Seizures
  • Altered mental status
  • Signs of raised ICP (vomiting, papilledema)

Diagnosis:

• CT or MRI with Contrast: Ring-enhancing lesion
• Avoid Lumbar Puncture: Risk of brain herniation
• Blood Cultures

Management:

• Antibiotics:
  • Ceftriaxone + Metronidazole + Vancomycin (broad-spectrum)
• Surgical Drainage: If large or causing mass effect
• Steroids: To reduce cerebral edema (if increased ICP)
• Seizure Prophylaxis: Due to risk of new-onset seizures

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3. Encephalitis

Definition:

Inflammation of the brain parenchyma itself, often due to viral infections.

Common Causes:

• Viral (most common):
  • Herpes Simplex Virus (HSV) – most common and severe
  • Enteroviruses, arboviruses (e.g., Japanese encephalitis), rabies
• Autoimmune Encephalitis: Anti-NMDA receptor encephalitis

Clinical Features:

• Fever
• Headache
• Altered mental status (confusion, agitation, coma)
• Seizures
• Focal neurological deficits
• Behavioral changes (especially in HSV encephalitis)

Complications:

• Permanent brain damage
• Seizures
• Memory deficits
• Death (if untreated, especially in HSV encephalitis)

Diagnosis:

• MRI: Hyperintensities, especially in temporal lobes (HSV)
• Lumbar Puncture:
  • CSF: Lymphocytic pleocytosis, normal glucose, ↑protein
• PCR for HSV: Gold standard for HSV encephalitis
• EEG: May show abnormal slow-wave activity

Management:

• Antiviral Therapy (immediate):
  • IV Acyclovir (for HSV encephalitis)
• Supportive Care: Airway protection, hydration, seizure control
• Steroids: If cerebral edema
• Antiepileptics: For seizure control

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Key Differences Between Meningitis, Brain Abscess, and Encephalitis

Feature	Meningitis	Brain Abscess	Encephalitis
Location	Meninges	Brain parenchyma (localized pus)	Brain parenchyma (diffuse inflammation)
Cause	Bacteria, viruses, TB, fungi	Bacteria (direct spread/hematogenous)	Viruses (HSV, JE), autoimmune
Symptoms	Fever, neck stiffness, headache	Headache, fever, focal deficits	Fever, confusion, seizures, altered behavior
CSF Findings	Abnormal (bacterial or viral)	Usually normal (avoid LP)	Lymphocytic pleocytosis, normal glucose
Imaging	CT/MRI if ICP suspected	Ring-enhancing lesion on CT/MRI	Temporal lobe involvement on MRI (HSV)
Treatment	Antibiotics + steroids	Antibiotics + possible surgery	Acyclovir + supportive care

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Key Points for Competitive Exams

1. Meningitis Triad = Fever + Neck stiffness + Altered mental status
2. Kernig’s and Brudzinski’s signs = Positive in meningitis
3. Empiric treatment of bacterial meningitis = Ceftriaxone + Vancomycin
4. HSV Encephalitis = Acyclovir (immediate)
5. Ring-enhancing lesion on CT = Brain abscess
6. Avoid lumbar puncture in brain abscess due to risk of herniation
7. Most common cause of encephalitis = HSV
8. PCR = Gold standard for diagnosing HSV encephalitis
9. CSF: Low glucose in bacterial meningitis, normal glucose in viral encephalitis
10. Seizure prophylaxis is important in brain abscess and encephalitis

Neurological Special Signs for Specific Diseases

Sign	Description	Associated Condition/Disease
Kernig’s Sign	Pain and resistance when extending the knee with the hip flexed at 90°	Meningitis
Brudzinski’s Sign	Involuntary hip and knee flexion when the neck is passively flexed	Meningitis
Babinski Sign	Dorsiflexion of the big toe with fanning of other toes on stroking the sole	Upper Motor Neuron Lesion, Stroke, MS
Romberg’s Test	Loss of balance when eyes are closed while standing with feet together	Sensory Ataxia (posterior column lesion), B12 deficiency
Hoffmann’s Sign	Flicking the nail of the middle finger causes thumb flexion	Upper Motor Neuron Lesion, Cervical Myelopathy
Lhermitte’s Sign	Electric shock-like sensation down the spine with neck flexion	Multiple Sclerosis, Cervical Spine Disorders
Chvostek’s Sign	Facial muscle twitching when tapping over the facial nerve	Hypocalcemia
Trousseau’s Sign	Carpopedal spasm induced by inflating a blood pressure cuff	Hypocalcemia, Tetany
Battle’s Sign	Bruising over the mastoid process	Basilar Skull Fracture
Raccoon Eyes	Periorbital ecchymosis (bruising around the eyes)	Basilar Skull Fracture
Decorticate Posturing	Flexion of arms, clenched fists, legs extended	Severe Brain Injury (lesion above brainstem)
Decerebrate Posturing	Extension of arms and legs, pronation of forearms	Brainstem Injury
Glasgow Coma Scale (GCS)	Scoring system to assess consciousness (Eye, Verbal, Motor responses)	Brain Injury Assessment
Pronator Drift Test	Downward drift of the arm when both arms are extended with palms up	Upper Motor Neuron Lesion
Macewen’s Sign	“Cracked pot” sound on percussion of the skull	Increased Intracranial Pressure in Infants
Doll’s Eye Reflex (Oculocephalic Reflex)	Eyes move opposite to head movement when turned (normal reflex)	Brainstem Integrity (absent in brain death)
Homan’s Sign	Pain in the calf with dorsiflexion of the foot	Deep Vein Thrombosis (DVT)
Gower’s Sign	Using hands to “climb up” the legs to stand due to proximal muscle weakness	Muscular Dystrophy
Grasp Reflex	Involuntary grasping of an object placed in the palm	Frontal Lobe Lesion, Primitive Reflex
Snout Reflex	Puckering of lips when tapping above the upper lip	Frontal Lobe Lesion, Primitive Reflex
Palmomental Reflex	Twitching of the chin when stroking the palm	Frontal Lobe Lesion, Primitive Reflex
Anosognosia	Lack of awareness of one’s neurological deficit	Right Parietal Lobe Lesion (often after stroke)
Apraxia	Inability to perform purposeful movements despite intact motor function	Parietal Lobe Lesion
Agraphesthesia	Inability to recognize numbers/letters traced on the skin	Parietal Lobe Lesion
Astereognosis	Inability to identify objects by touch	Parietal Lobe Lesion
Tandem Walking Test	Difficulty walking heel-to-toe in a straight line	Cerebellar Ataxia
Heel-to-Shin Test	Incoordination when sliding heel down the opposite shin	Cerebellar Dysfunction
Finger-to-Nose Test	Dysmetria (overshooting or missing the target)	Cerebellar Dysfunction
Snellen Chart Test	Measures visual acuity	Optic Nerve (CN II) Assessment
Weber’s Test	Tuning fork placed on forehead; sound lateralization	Sensorineural or Conductive Hearing Loss
Rinne’s Test	Comparing air conduction vs. bone conduction using a tuning fork	Conductive or Sensorineural Hearing Loss
Marcus Gunn Pupil (RAPD)	Pupil dilates instead of constricting during swinging light test	Optic Nerve Lesion (CN II), Afferent Defect
Myerson’s Sign (Glabellar Tap Reflex)	Repetitive blinking when tapping between eyebrows	Parkinson’s Disease
Clonus	Repetitive, rhythmic muscle contractions after sudden stretching	Upper Motor Neuron Lesion
Froment’s Sign	Weak grip with compensatory thumb flexion during pinch test	Ulnar Nerve Palsy
Romberg Sign	Swaying or loss of balance when standing with feet together, eyes closed	Sensory Ataxia (posterior column dysfunction)

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Key Notes for Exams:

1. Positive Kernig’s and Brudzinski’s signs = Meningitis.
2. Babinski Sign indicates Upper Motor Neuron Lesion.
3. Romberg Test differentiates sensory from cerebellar ataxia.
4. Decorticate = Lesion above the brainstem; Decerebrate = Brainstem lesion (worse prognosis).
5. Lhermitte’s Sign = Electric shock-like sensation (Multiple Sclerosis).
6. Doll’s Eye Reflex = Tests brainstem function (absent in brain death).
7. Pronator Drift = Early sign of Upper Motor Neuron weakness.
8. Battle’s Sign & Raccoon Eyes = Basilar Skull Fracture.
9. Trousseau’s and Chvostek’s Signs = Hypocalcemia.
10. Positive Froment’s Sign = Ulnar nerve palsy.

1. Multiple Sclerosis (MS)

Definition:

An autoimmune demyelinating disease of the central nervous system (CNS) affecting the brain and spinal cord.

Pathophysiology:

• Immune-mediated attack on myelin sheath, causing inflammation and scarring (sclerosis).
• Leads to disrupted nerve signal transmission.

Types:

• Relapsing-Remitting (RRMS): Most common
• Secondary Progressive (SPMS)
• Primary Progressive (PPMS)
• Progressive-Relapsing (PRMS)

Clinical Features:

• Optic Neuritis: Blurred vision, pain with eye movement
• Lhermitte’s Sign: Electric shock-like sensation down the spine
• Diplopia (double vision)
• Motor Weakness: Spasticity, fatigue
• Sensory Loss: Numbness, tingling
• Bladder/Bowel Dysfunction
• Cognitive Impairment

Diagnosis:

• MRI: Shows demyelinating plaques in CNS
• Lumbar Puncture: Oligoclonal bands in CSF
• Evoked Potentials: Delayed nerve conduction

Management:

• Acute Relapse: IV corticosteroids (methylprednisolone)
• Disease-Modifying Therapy (DMT): Interferon-beta, glatiramer acetate
• Symptomatic Treatment: Muscle relaxants, antispasmodics, physical therapy

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2. Myasthenia Gravis (MG)

Definition:

A chronic autoimmune neuromuscular disorder causing weakness of skeletal muscles due to antibodies against acetylcholine receptors at the neuromuscular junction.

Pathophysiology:

• Autoantibodies block ACh receptors, impairing nerve impulse transmission to muscles.

Clinical Features:

• Fluctuating Muscle Weakness: Worsens with activity, improves with rest
• Ptosis (drooping eyelids)
• Diplopia (double vision)
• Dysphagia (difficulty swallowing)
• Weakness in limbs and neck muscles
• Myasthenic Crisis: Life-threatening respiratory muscle weakness

Diagnosis:

• Tensilon Test (Edrophonium): Temporary improvement in muscle strength
• Anti-AChR Antibodies: Positive in most cases
• EMG: Decreased muscle response with repeated stimulation
• CT/MRI: To rule out thymoma

Management:

• Acetylcholinesterase Inhibitors: Pyridostigmine (first-line)
• Immunosuppressants: Prednisone, azathioprine
• Plasmapheresis or IVIG: In severe cases or crisis
• Thymectomy: If thymoma is present

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3. Guillain-Barré Syndrome (GBS)

Definition:

An acute autoimmune polyneuropathy causing rapid-onset muscle weakness due to demyelination of peripheral nerves.

Pathophysiology:

• Often follows a viral or bacterial infection (e.g., Campylobacter jejuni).
• Immune response mistakenly attacks peripheral nerve myelin.

Clinical Features:

• Ascending Muscle Weakness: Starts in legs, progresses upward
• Areflexia: Loss of deep tendon reflexes
• Paresthesias: Numbness, tingling
• Autonomic Dysfunction: BP fluctuations, arrhythmias
• Respiratory Failure: Due to diaphragm involvement (life-threatening)

Diagnosis:

• Lumbar Puncture: Elevated protein with normal WBC (albuminocytologic dissociation)
• Nerve Conduction Studies: Slowed conduction velocity
• EMG: Shows demyelination

Management:

• IV Immunoglobulin (IVIG) or Plasmapheresis (first-line)
• Supportive Care: Ventilatory support if needed
• Avoid corticosteroids (ineffective in GBS)

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4. Parkinsonism (Parkinson’s Disease)

Definition:

A progressive neurodegenerative disorder characterized by dopamine deficiency in the basal ganglia due to degeneration of dopaminergic neurons in the substantia nigra.

Clinical Features (TRAP):

• T – Tremor: Resting tremor (“pill-rolling”)
• R – Rigidity: Lead-pipe or cogwheel stiffness
• A – Akinesia/Bradykinesia: Slowness of movement
• P – Postural Instability: Balance problems

Other symptoms:

• Shuffling gait, masked facies, micrographia (small handwriting), drooling, depression, dementia (late stages)

Diagnosis:

• Clinical Diagnosis: Based on history and physical exam
• Levodopa Response Test: Improvement with dopaminergic therapy
• MRI/CT: To rule out secondary causes (e.g., stroke, tumor)

Management:

• Levodopa + Carbidopa: First-line treatment
• Dopamine Agonists: Pramipexole, ropinirole
• MAO-B Inhibitors: Selegiline, rasagiline
• COMT Inhibitors: Entacapone
• Deep Brain Stimulation: For advanced disease

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5. Alzheimer’s Disease (AD)

Definition:

A progressive neurodegenerative disorder causing dementia, primarily affecting memory, thinking, and behavior.

Pathophysiology:

• Accumulation of beta-amyloid plaques and neurofibrillary tangles (tau protein) in the brain.
• Leads to synaptic dysfunction and neuronal death, especially in the hippocampus.

Risk Factors:

• Advanced age, family history, genetic predisposition (ApoE4 gene)

Clinical Features:

• Early Stage: Memory loss, difficulty with learning new information
• Moderate Stage: Language difficulties, disorientation, mood changes
• Late Stage: Severe cognitive impairment, loss of motor functions, incontinence

Diagnosis:

• Clinical Assessment: Cognitive testing (MMSE, MoCA)
• Neuroimaging (MRI/CT): Brain atrophy, particularly in hippocampus
• Definitive Diagnosis: Post-mortem brain biopsy (not routinely done)

Management:

• Cholinesterase Inhibitors: Donepezil, rivastigmine, galantamine
• NMDA Receptor Antagonist: Memantine (for moderate to severe AD)
• Supportive Care: Cognitive therapy, caregiver support, environmental modifications

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Key Differences Between Neurological Disorders

Feature	Multiple Sclerosis (MS)	Myasthenia Gravis (MG)	Guillain-Barré Syndrome (GBS)	Parkinson’s Disease (PD)	Alzheimer’s Disease (AD)
Cause	Autoimmune CNS demyelination	Autoimmune attack on ACh receptors	Autoimmune PNS demyelination	Dopamine deficiency (substantia nigra)	Neurodegeneration (beta-amyloid plaques)
Onset	Young adults (20–40 yrs)	Any age, more common in women	Rapid onset (days to weeks)	Gradual onset, >60 years	Gradual cognitive decline, elderly
Symptoms	Vision problems, weakness, spasticity	Muscle weakness (worsens with use)	Ascending paralysis, areflexia	Tremor, rigidity, bradykinesia	Memory loss, confusion
Reflexes	Hyperreflexia	Normal reflexes	Absent reflexes (areflexia)	Normal reflexes	Normal reflexes
Diagnosis	MRI, CSF (oligoclonal bands)	Tensilon test, anti-AChR antibodies	CSF (↑ protein, normal cells)	Clinical, Levodopa response	Clinical, cognitive testing, MRI
Treatment	Steroids, interferons	Pyridostigmine, immunosuppressants	IVIG, plasmapheresis	Levodopa, dopamine agonists	Cholinesterase inhibitors, memantine
Prognosis	Variable, relapsing-remitting common	Good with treatment	Often full recovery	Progressive, managed with medication	Progressive, supportive care

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Key Points for Competitive Exams

1. MS = Lhermitte’s Sign + Oligoclonal bands in CSF
2. Myasthenia Gravis = Fluctuating weakness, positive Tensilon Test
3. GBS = Ascending paralysis with albuminocytologic dissociation in CSF
4. Parkinson’s Disease = TRAP symptoms (Tremor, Rigidity, Akinesia, Postural Instability)
5. Alzheimer’s = Memory loss, beta-amyloid plaques, treated with donepezil and memantine
6. IVIG/Plasmapheresis = First-line for GBS; Steroids = Contraindicated
7. Myasthenic Crisis = Emergency; can cause respiratory failure
8. Parkinson’s Tremor = Resting tremor (“pill-rolling”); improves with movement
9. Multiple Sclerosis = MRI shows periventricular white matter plaques
10. Alzheimer’s Disease = Most common cause of dementia in the elderly

1. Neuralgia

Definition:

Neuralgia refers to sharp, burning, or stabbing pain along the course of a nerve.

Types:

• Trigeminal Neuralgia: Involves the trigeminal nerve (CN V); severe facial pain.
• Postherpetic Neuralgia: Follows shingles infection (herpes zoster).
• Glossopharyngeal Neuralgia: Pain in the throat, tonsillar area, and ear.

Clinical Features:

• Sudden, severe, electric shock-like pain.
• Triggered by light touch, chewing, speaking.
• Paroxysmal attacks lasting seconds to minutes.

Diagnosis:

• Clinical Assessment: History of episodic, sharp pain.
• MRI: To rule out structural causes (tumors, vascular compression).

Management:

• First-line: Carbamazepine (anticonvulsant).
• Other Options: Gabapentin, baclofen.
• Surgical: Microvascular decompression (if refractory to medications).

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2. Bell’s Palsy

Definition:

Acute unilateral facial nerve (CN VII) paralysis of unknown cause (idiopathic), often linked to viral infections.

Clinical Features:

• Sudden onset of unilateral facial weakness (both upper and lower face).
• Inability to close the eye, drooping of the mouth, loss of nasolabial fold.
• Loss of taste (anterior 2/3 of the tongue), hyperacusis, decreased lacrimation.

Diagnosis:

• Clinical Diagnosis: Based on sudden facial paralysis.
• Exclusion: Rule out stroke (stroke spares forehead muscles).

Management:

• Corticosteroids: Prednisolone (early initiation improves recovery).
• Antivirals: Acyclovir (if viral etiology suspected).
• Eye Care: Artificial tears, eye patch (to prevent corneal ulceration).
• Prognosis: Good, most recover fully within weeks to months.

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3. Peripheral Neuropathies

Definition:

Damage to peripheral nerves, causing weakness, numbness, and pain, typically in the hands and feet.

Causes:

• Diabetes (most common)
• Alcoholism
• Vitamin B12 deficiency
• Infections (HIV, leprosy)
• Toxins (chemotherapy, heavy metals)

Clinical Features:

• Sensory Symptoms: Numbness, tingling (paresthesia), burning pain.
• Motor Symptoms: Muscle weakness, foot drop.
• Autonomic Dysfunction: BP fluctuations, bladder/bowel issues.

Diagnosis:

• Nerve Conduction Studies/EMG: Confirms neuropathy.
• Blood Tests: Glucose, B12, thyroid function, toxins.
• Nerve Biopsy: Rarely needed.

Management:

• Treat Underlying Cause: Control diabetes, correct deficiencies.
• Medications: Gabapentin, pregabalin, antidepressants (amitriptyline).
• Pain Management: NSAIDs, opioids (if severe).

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4. Brain and Spinal Cord Tumors

Brain Tumors:

• Types:
  • Primary: Gliomas, meningiomas, pituitary adenomas.
  • Secondary (Metastatic): From lung, breast, melanoma.
• Symptoms:
  • Headache (worse in the morning)
  • Seizures
  • Focal neurological deficits
  • Increased ICP: Nausea, vomiting, papilledema
• Diagnosis:
  • MRI with contrast (gold standard)
  • Biopsy: For histopathological confirmation
• Treatment:
  • Surgery (craniotomy)
  • Radiotherapy, chemotherapy
  • Steroids to reduce edema

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Spinal Cord Tumors:

• Types:
  • Intramedullary: Astrocytomas, ependymomas
  • Extramedullary: Meningiomas, schwannomas
• Symptoms:
  • Back pain (worse at night)
  • Motor weakness, sensory loss
  • Bladder/bowel dysfunction
• Diagnosis:
  • MRI spine with contrast
  • Biopsy (if needed)
• Treatment:
  • Surgical decompression
  • Radiation therapy
  • Steroids to reduce inflammation

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5. Huntington’s Disease

Definition:

A genetic neurodegenerative disorder causing progressive movement, cognitive, and psychiatric symptoms.

Inheritance:

• Autosomal dominant (mutation in the HTT gene, CAG repeat expansion).

Clinical Features:

• Chorea: Involuntary, jerky movements
• Cognitive Decline: Dementia, memory loss
• Psychiatric Symptoms: Depression, irritability, psychosis

Diagnosis:

• Genetic Testing: Confirms CAG repeat expansion in HTT gene
• MRI: Shows caudate nucleus atrophy

Management:

• Symptomatic Treatment:
  • Tetrabenazine (for chorea)
  • Antipsychotics (for behavioral symptoms)
• Supportive Care: Physical therapy, psychiatric support
• Prognosis: Progressive, fatal within 10–20 years of onset

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6. Muscular Dystrophies

Definition:

A group of genetic disorders causing progressive muscle weakness and wasting.

Common Types:

• Duchenne Muscular Dystrophy (DMD): Most severe, affects boys (X-linked recessive).
• Becker Muscular Dystrophy: Milder than DMD.
• Myotonic Dystrophy: Affects muscles and other organs.

Clinical Features (DMD):

• Onset <5 years
• Gower’s Sign: Child uses hands to “climb up” legs to stand
• Calf pseudohypertrophy
• Progressive weakness (proximal muscles first)
• Wheelchair-bound by adolescence

Diagnosis:

• Genetic Testing: Dystrophin gene mutation
• Elevated CK Levels: Indicates muscle damage
• Muscle Biopsy: Shows dystrophin deficiency

Management:

• Corticosteroids: Slow disease progression
• Physical Therapy: To maintain mobility
• Cardiac & Respiratory Support: As disease progresses
• Prognosis: DMD often fatal in early adulthood due to respiratory/cardiac failure

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7. Herniation of the Intervertebral Disc

Definition:

Displacement of the nucleus pulposus through the annulus fibrosus, compressing spinal nerves.

Common Site:

• Lumbar spine (L4–L5, L5–S1) most common
• Cervical spine less commonly affected

Risk Factors:

Heavy lifting, obesity, trauma, aging

Clinical Features:

• Radicular Pain: Shooting pain radiating to legs (sciatica)
• Motor Weakness: Foot drop, weakness in affected myotome
• Sensory Changes: Numbness, tingling
• Positive Straight Leg Raise Test (SLR): Reproduces radicular pain
• Cauda Equina Syndrome (emergency):
  • Saddle anesthesia
  • Bladder/bowel incontinence
  • Bilateral leg weakness

Diagnosis:

• MRI spine (gold standard)
• X-rays: Rule out other causes (fractures, tumors)

Management:

• Conservative: Rest, NSAIDs, physical therapy
• Epidural Steroid Injections: For persistent pain
• Surgical: Microdiscectomy or laminectomy (if neurological deficits or cauda equina syndrome)

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Key Differences Between the Conditions

Condition	Key Feature	Diagnosis	Treatment
Neuralgia	Sharp, electric-like nerve pain	Clinical, MRI (if needed)	Carbamazepine, gabapentin
Bell’s Palsy	Unilateral facial paralysis	Clinical, rule out stroke	Steroids, antivirals, eye protection
Peripheral Neuropathy	Numbness, tingling, weakness	Nerve conduction studies, labs	Treat cause, gabapentin
Brain Tumor	Headache, seizures, focal deficits	MRI with contrast, biopsy	Surgery, radiotherapy, chemotherapy
Spinal Cord Tumor	Back pain, motor/sensory deficits	MRI spine	Surgery, radiotherapy
Huntington’s Disease	Chorea, cognitive decline	Genetic testing	Symptomatic (tetrabenazine)
Muscular Dystrophy	Progressive muscle weakness	Genetic test, CK levels, biopsy	Steroids, supportive care
IV Disc Herniation	Back pain with radiculopathy	MRI spine	NSAIDs, surgery (if severe)

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Key Points for Competitive Exams

1. Neuralgia (Trigeminal) = Carbamazepine is first-line treatment.
2. Bell’s Palsy = Sudden facial paralysis; steroids improve recovery.
3. Peripheral Neuropathy = Diabetes is the most common cause.
4. Brain Tumor = MRI with contrast is the gold standard.
5. Spinal Cord Tumor = Presents with back pain, MRI spine diagnostic.
6. Huntington’s = Chorea + dementia, autosomal dominant inheritance.
7. Muscular Dystrophy = Gower’s sign in Duchenne MD.
8. IV Disc Herniation = Positive Straight Leg Raise Test (SLR).
9. Cauda Equina Syndrome = Surgical emergency (urgent decompression).
10. Duchenne MD = X-linked recessive, elevated CK levels, fatal in early adulthood.

1. Alternate Therapies for Neurological Disorders

A. Complementary and Alternative Therapies (CAM):

• Physical Therapy (PT):
  • Improves mobility, muscle strength, and coordination.
  • Used in conditions like stroke, multiple sclerosis, Parkinson’s disease.
• Occupational Therapy (OT):
  • Helps patients regain skills needed for daily living.
  • Important in stroke rehabilitation, spinal cord injury, neuromuscular disorders.
• Speech Therapy:
  • Assists with speech and swallowing difficulties.
  • Common in stroke, ALS, Parkinson’s disease.
• Cognitive Behavioral Therapy (CBT):
  • Manages depression, anxiety, and cognitive deficits.
  • Helpful in epilepsy, chronic pain, Alzheimer’s disease.
• Acupuncture:
  • Used to relieve chronic pain, headaches, and neuropathic conditions.
  • Evidence suggests benefits in migraine prophylaxis.
• Meditation and Mindfulness:
  • Reduces stress, improves focus, and manages chronic pain and insomnia.
  • Beneficial in multiple sclerosis, anxiety disorders, epilepsy.
• Biofeedback Therapy:
  • Helps control physiological functions like heart rate and muscle tension.
  • Used in migraine, tension headaches, stress-related neurological disorders.
• Herbal and Nutritional Supplements:
  • Omega-3 fatty acids: Cognitive function in Alzheimer’s.
  • Vitamin D and B12: Neuropathy prevention in deficiency states.
  • Ginkgo Biloba: Claimed to improve memory (limited evidence in dementia).
• Music and Art Therapy:
  • Enhances cognitive functions and reduces agitation in dementia patients.
  • Improves mood in Parkinson’s disease.

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2. Drugs Used in the Treatment of Neurological Disorders

A. Antiepileptic Drugs (AEDs):

Used to control seizures and epilepsy.

• Phenytoin: Blocks sodium channels; used for tonic-clonic seizures.
• Valproic Acid: Broad-spectrum AED; effective in generalized seizures.
• Carbamazepine: First-line for focal seizures and trigeminal neuralgia.
• Levetiracetam: Used in focal and generalized seizures (fewer drug interactions).
• Lamotrigine: Effective for focal seizures and bipolar disorder.
• Topiramate: Used for epilepsy and migraine prophylaxis.

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B. Antiparkinsonian Drugs:

Used in Parkinson’s disease to improve motor symptoms.

• Levodopa + Carbidopa: Gold standard therapy (dopamine precursor).
• Dopamine Agonists: Pramipexole, ropinirole.
• MAO-B Inhibitors: Selegiline, rasagiline (reduce dopamine breakdown).
• COMT Inhibitors: Entacapone (prolongs the effect of levodopa).
• Anticholinergics: Trihexyphenidyl (for tremor in younger patients).

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C. Drugs for Multiple Sclerosis (MS):

• Acute Exacerbations: High-dose IV corticosteroids (methylprednisolone).
• Disease-Modifying Therapies (DMTs):
  • Interferon-beta
  • Glatiramer acetate
  • Fingolimod
  • Natalizumab (monoclonal antibody)

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D. Drugs for Alzheimer’s Disease:

• Cholinesterase Inhibitors: Donepezil, rivastigmine, galantamine (improve cognitive function).
• NMDA Receptor Antagonist: Memantine (for moderate to severe Alzheimer’s).
• Antipsychotics: Used cautiously for behavioral symptoms.

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E. Drugs for Myasthenia Gravis:

• Acetylcholinesterase Inhibitors: Pyridostigmine (improves neuromuscular transmission).
• Immunosuppressants: Prednisone, azathioprine, mycophenolate.
• Plasmapheresis or IVIG: Used during myasthenic crisis or severe cases.

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F. Drugs for Neuropathic Pain:

• Anticonvulsants: Gabapentin, pregabalin (for diabetic neuropathy, postherpetic neuralgia).
• Antidepressants: Amitriptyline, duloxetine (modulate pain pathways).
• Topical Agents: Capsaicin cream, lidocaine patches.

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G. Muscle Relaxants (for Spasticity):

• Baclofen: GABA agonist, reduces spasticity in MS, spinal cord injuries.
• Tizanidine: Alpha-2 adrenergic agonist, reduces muscle tone.
• Diazepam: Benzodiazepine with muscle relaxant properties.

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H. Migraine Treatment:

• Acute (Abortive) Therapy:
  • Triptans (sumatriptan, rizatriptan)
  • NSAIDs (ibuprofen, naproxen)
  • Ergot alkaloids (ergotamine)
• Preventive Therapy:
  • Beta-blockers (propranolol)
  • Anticonvulsants (topiramate, valproic acid)
  • Antidepressants (amitriptyline)

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I. Drugs for Stroke:

• Ischemic Stroke:
  • Thrombolytics (tPA): If within 4.5 hours of symptom onset
  • Antiplatelets: Aspirin, clopidogrel
  • Anticoagulants: Warfarin, DOACs (if cardioembolic source)
• Hemorrhagic Stroke:
  • BP control (labetalol, nicardipine)
  • Reverse anticoagulation if needed

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J. Immunomodulatory and Biologic Agents:

• Used in autoimmune neurological disorders (e.g., MS, myasthenia gravis, GBS).
• Rituximab: B-cell depleting agent (for MS, autoimmune encephalitis).
• IV Immunoglobulin (IVIG): For Guillain-Barré syndrome, myasthenic crisis.
• Plasmapheresis: Removes autoantibodies from the blood.

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Key Points for Competitive Exams

1. Levodopa + Carbidopa = First-line therapy for Parkinson’s disease.
2. Donepezil and Memantine = Key drugs for Alzheimer’s disease.
3. Gabapentin/Pregabalin = First-line for neuropathic pain.
4. Interferon-beta = Disease-modifying therapy for MS.
5. Pyridostigmine = Mainstay of treatment for myasthenia gravis.
6. tPA = Thrombolytic therapy for ischemic stroke (within 4.5 hours).
7. Triptans = First-line abortive treatment for migraines.
8. IVIG/Plasmapheresis = First-line for Guillain-Barré syndrome.
9. Carbamazepine = First-line for trigeminal neuralgia.
10. High-dose steroids = Used in MS relapses and Bell’s palsy.