NEUROLOGY FOR MRCP. Neurology for MRCP Downloaded from The Essential Guide to Neurology for MRCP Part 1, Part 2 and PACES

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1 NEUROLOGY FOR MRCP The Essential Guide to Neurology for MRCP Part 1, Part 2 and PACES

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3 MRCP NEUROLOGY FOR MRCP The Essential Guide to Neurology for MRCP Part 1, Part 2 and PACES Jonathan D Rohrer Jonathan Kennedy UCL Institute of Neurology, Queen Square, UK ICP Imperial College Press

4 Published by Imperial College Press 57 Shelton Street Covent Garden London WC2H 9HE Distributed by World Scientific Publishing Co. Pte. Ltd. 5 Toh Tuck Link, Singapore USA office: 27 Warren Street, Suite , Hackensack, NJ UK office: 57 Shelton Street, Covent Garden, London WC2H 9HE British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library. Cover image: Dr. Michael Miller & MTP Inc. Tokyo NEUROLOGY FOR MRCP The Essential Guide to Neurology for MRCP Part 1, Part 2 and PACES Copyright 2011 by Imperial College Press All rights reserved. This book, or parts thereof, may not be reproduced in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system now known or to be invented, without written permission from the Publisher. For photocopying of material in this volume, please pay a copying fee through the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, USA. In this case permission to photocopy is not required from the publisher. ISBN (pbk) ISBN (pbk) Typeset by Stallion Press enquiries@stallionpress.com Printed in Singapore.

5 Contents List of Figures Acknowledgements Introduction Part 1 Neurological Disorders 1 Chapter 1 Basic Anatomy 3 Chapter 2 Dementia and Delirium 10 Chapter 3 Epilepsy 15 Chapter 4 Raised Intracranial Pressure 20 Chapter 5 Cerebrovascular Disease 22 Chapter 6 Headache 28 Chapter 7 Neuroinfectious Disease 30 Chapter 8 Movement Disorders 33 Chapter 9 Multiple Sclerosis 40 Chapter 10 Cerebellar Disease 43 Chapter 11 Cranial Nerve Disorders 45 Chapter 12 Disorders of the Spinal Cord 55 Chapter 13 Anterior Horn Cell Disorders 60 Chapter 14 Nerve Root and Plexus Disease 62 Chapter 15 Mononeuropathies and Mononeuritis Multiplex 65 Chapter 16 Peripheral Neuropathies 68 Chapter 17 Neuromuscular Junction Disorders 73 Chapter 18 Muscle Disorders 77 Chapter 19 Investigations 81 vii ix xi v

6 vi Contents Part 2 Neurological Examination for PACES 87 Chapter 20 Cranial Nerve Territory Examination 89 Chapter 21 Limb Examination 102 Part 3 Questions for Parts 1 and Questions for Part Questions for Part Answers to Questions 154 Index 157

7 List of Figures 1. Cerebral hemisphere showing the frontal, temporal, parietal and occipital lobes A diagram of the brainstem showing the position of the cranial nerve nuclei Anterior and posterior dermatomal map CT scans showing a left middle cerebral artery infarction (on the left) and right hemisphere intracerebral haemorrhage (on the right) MRI scans showing demyelination in the brain and spine A schematic diagram explaining spinal cord syndromes Examples of MRI scans showing coronal T1, axial T2 and axial FLAIR images A diagram showing visual field defects. 93 vii

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9 Acknowledgements We would like to thank Rebecca Miller and Fiona Kennedy for their support during the writing of the book. We would also like to thank Dr Michael Miller for providing the cover design and Dr Edward Wild for kind permission to use the dermatomal map. Lastly, we would also like to thank Dr Camilla Clark, Dr Lucy Reynolds and in particular Dr Phillip Kennedy for reviewing the manuscript. ix

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11 Introduction Neurology is commonly portrayed as a difficult topic in the MRCP examinations. This book has been written to try and help you through both the written and clinical sections of the exam and hopefully prove that Neurology is not as difficult as it may at first seem. The book is not designed, however, to be a definitive Neurology textbook but rather a revision guide for the MRCP exams. The first section of the book describes the neurological disorders you need to know about for the MRCP and will be useful throughout the different parts of the exam. The second section of the book concentrates on the PACES section of the exam. The third section provides questions to test your knowledge before the Part 1 and Part 2 exams. Each section is set out in roughly anatomical fashion, starting with disorders of the cortex and moving down through the nervous system to finish at the muscle. This systematic way of thinking is useful for both the written and clinical exam and will be used as the basis for the book. It is important to recognise that in practice, different neurologists may all perform the neurological examination slightly differently and in their own idiosyncratic way. For PACES it is advisable to perform a standard textbook neurological examination as set out in Section 2 of this book. Dr Jonathan Rohrer MRCP (UK) Dr Jonathan Kennedy MRCP (UK) xi