DIMS Lectures Neurology PDF

Here is the complete pdf lecture of neurology by Dr. Tahir Malik 

Introduction to Clinical Neurology

Neurology is the branch of medicine dealing with disorders of the nervous system, including the brain, spinal cord, and peripheral nerves.

This guide covers common neurological diseases, their pathophysiology, clinical features, diagnostic approaches, and evidence-based management strategies.

Stroke

Definition:

A stroke is an acute neurological deficit due to ischemia (85%) or hemorrhage (15%) in the brain.

Types:

• Ischemic Stroke: Due to thrombotic or embolic occlusion of cerebral arteries.
• Hemorrhagic Stroke: Intracerebral or subarachnoid hemorrhage.
• Transient Ischemic Attack (TIA): Temporary neurological symptoms without infarction.

Pathophysiology:

• Ischemic Stroke: Reduced cerebral perfusion leads to infarction.
• Hemorrhagic Stroke: Rupture of blood vessels leads to increased intracranial pressure and brain damage.

Clinical Features:

• Sudden onset hemiparesis or hemiplegia.
• Aphasia (speech difficulty) if the dominant hemisphere is affected.
• Facial droop, dysphagia, visual disturbances.
• Loss of balance and coordination.

Diagnosis:

• CT Scan (Non-Contrast): Differentiates ischemic vs hemorrhagic stroke.
• MRI Brain: Identifies early ischemic changes.
• Carotid Doppler: Assesses for carotid artery stenosis.
• ECG & Echocardiography: Detects embolic sources from atrial fibrillation.

Management:

• Acute Ischemic Stroke:
  • Thrombolysis with Alteplase (tPA) if within 4.5 hours.
  • Aspirin and antiplatelets (Clopidogrel) for secondary prevention.
  • Statins (Atorvastatin) to prevent atherosclerosis progression.
• Hemorrhagic Stroke:
  • Blood pressure control (Labetalol, Nicardipine).
  • Surgical evacuation in large hematomas.

Epilepsy

Definition:

Epilepsy is a chronic neurological disorder characterized by recurrent unprovoked seizures.

Types of Seizures:

• Focal Seizures: Limited to one hemisphere; can be motor or non-motor.
• Generalized Seizures: Involve both hemispheres (e.g., tonic-clonic, absence seizures).

Pathophysiology:

• Abnormal electrical activity in the brain due to imbalance between excitatory and inhibitory neurotransmitters (Glutamate & GABA).

Clinical Features:

• Tonic-Clonic Seizures: Loss of consciousness, convulsions, postictal confusion.
• Absence Seizures: Brief staring episodes, no postictal state.
• Focal Seizures: May have altered awareness or motor symptoms.

Diagnosis:

• EEG (Electroencephalogram): Confirms abnormal electrical activity.
• MRI Brain: Identifies structural causes (tumors, cortical dysplasia).

Management:

• First-line Anti-Seizure Medications (ASMs):
  • Valproate (Generalized seizures).
  • Carbamazepine (Focal seizures).
  • Levetiracetam (Well-tolerated in all types).
• Lifestyle Modifications: Sleep hygiene, avoiding alcohol, stress reduction.
• Surgical Interventions: For refractory epilepsy (e.g., temporal lobectomy).

Parkinson’s Disease

Definition:

A progressive neurodegenerative disorder affecting dopaminergic neurons in the substantia nigra.

Pathophysiology:

• Loss of dopamine in the basal ganglia results in motor dysfunction.

Clinical Features:

• Bradykinesia (slowness of movement).
• Tremor at rest (pill-rolling tremor).
• Rigidity (lead-pipe or cogwheel rigidity).
• Postural instability, shuffling gait.

Diagnosis:

• Clinical diagnosis based on characteristic motor symptoms.
• DaTscan (Dopamine transporter imaging) for confirmation in unclear cases.

Management:

• Levodopa-Carbidopa (First-line).
• Dopamine Agonists (Pramipexole, Ropinirole).
• MAO-B Inhibitors (Selegiline, Rasagiline).
• Physiotherapy and exercise for motor function improvement.

Multiple Sclerosis (MS)

Definition:

A chronic autoimmune demyelinating disease affecting the central nervous system (CNS).

Pathophysiology:

• Immune-mediated destruction of myelin in the CNS leads to axonal dysfunction.
• Lesions appear in multiple locations (“dissemination in space & time”).

Clinical Features:

• Optic neuritis (painful vision loss).
• Limb weakness, ataxia, spasticity.
• Bladder dysfunction, cognitive impairment.
• Lhermitte’s sign (electric shock-like sensation down the spine).

Diagnosis:

• MRI Brain & Spine: White matter lesions in periventricular areas.
• Lumbar Puncture: Oligoclonal bands in CSF.

Management:

• Acute Relapses: IV methylprednisolone.
• Disease-Modifying Therapy (DMT):
  • Interferon-beta, Natalizumab, Ocrelizumab.
• Symptomatic Treatment: Baclofen for spasticity, Amitriptyline for neuropathic pain.

Case Example: A 35-Year-Old with Sudden Weakness

A 35-year-old female presents with sudden right-sided weakness, slurred speech, and facial droop. Examination shows upper motor neuron (UMN) signs. Non-contrast CT is negative, but MRI brain shows acute ischemia. 

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Diagnosis: Acute Ischemic Stroke (Left MCA Infarct).

give IV thrombolysis (tPA) within 3 hours, followed by dual antiplatelet therapy (Aspirin + Clopidogrel) for stroke prevention.

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