Category Archives: Neurological Diseases and Diseases of Voluntary Muscle

Congenital and inherited diseases

CEREBRAL PALSY This term describes disorders apparent at birth or in childhood due to brain damage in the neonatal period leading to non-progressive deficits. Mental retardation, varying from severe intellectual impairment to mild learning disorders, is common in all forms of cerebral palsy, but severe physical disability is not necessarily associated with a severe defect in higher erebral function. CAUSES Th

Headache, migraine and facial pain

Tension headache’ The vast majority of chronic and recurrent headaches are believed, on no good evidence, to be due to ‘tension’ within the scalp muscles. What is certain is that they are, in terms of pathology, innocent. ‘Tight band’ sensations, pressure behind the eyes, and throbbing and bursting sensations are common. depressed skull fracture or meningeal tear may be necessary


In the cranial nerves, herpes zoster has a predilection for the fifth and seventh nerve. ‘Ophthalmic herpes’ is infection of the first division of the fifth nerve and may lead to corneal scarring and secondary panophthalmitis. ‘Geniculate herpes’ (the Ramsay Hunt syndrome, seep. 889) leads to facial palsy accompanied by vesicles on  the pinna, external auditory meatus and fauces. The l


Hydrocephalus means that there is an excessive amountof CSF within the cranium. Although this also occurs in  cerebral atrophy, in practice the term hydrocephalus is used to describe different syndromes in which there is, or has been, obstruction to CSF outflow with consequent high pressure and dilatation of the cerebral ventricles. Exceptionally an increase in CSF production occurs. • Infantile hydrocephalu

Intracranial turnours

Primary intracranial tumours account for approximately 10% of all neoplasms. The commoner varieties of tumours are outlined in Table 18.46; around one-quarter are metastases (see Fig. 18.20e). Differences between overall annual incidence rates (see Table 18.1) and presentation as clinical problems (Table 18.46) are accounted for by the fact that small meningiomas and cerebral metastases are commonly found unex

Infective and inflammatory disease

MENINGITIS Meningitis (inflammation of the meninges) may becaused by: • Bacteria • Viruses • Fungi • Other organisms • Malignant cells • Drugs and contrast media • Blood (following SAH) The term is usually restricted to inflammation due to infective agents (Table 18.41). Microorganisms reach the Bacteria Neisseria meningitidis” Haemophilus irdluenzse: Streptococcus pneumoniee” Staphylococ

Multiple sclerosis

MS is a common disease of unknown cause in which there are multiple areas of demyelination within the brain and spinal cord. These are ‘disseminated in time and place’ (hence the old name ‘disseminated sclerosis’). An acquired defect in the oligodendroglial cells that produce myelin is responsible. The commonest age of onset is between 20 and 35 years, the disease being commoner in wo


Chorea consists of jerky, quasi-purposive and sometimesexplosive movements, following each other but flitting  from one part of the body to another. The causes of chorea are listed in Table 18.38; the commoner conditions are outlined below. Huntington’s disease Relentlessly progressive chorea and dementia in middle life are the hallmarks of this inherited disease. The prevalence of the disease is about 1

Parkinson’s disease and other movement disorders

Disorders of movement can be classified broadly into akinetic-rigid syndromes, where there is loss of move ment with increase in muscle tone, and dyskinesias, where there are added movements outside voluntary control. Both are due to disorders of neurotransmitters of the extrapyramidal system. Parkinson’s disease is much the commonest of these conditions. A classification of movement disorders i given i


Episodes of transient disturbance of consciousness and falls are common clinical problems. It is usually possible to distinguish between a ‘fit’ (a seizure), a ‘faint’ (syncope) and other types of attack from the history given by the patient and the account of an eye witness. Syncope (situational or vasovagal) ‘Faint’ Cough Effort Micturition Carotid sinus Epilepsy Narcolepsy