learning neurology

hello


i have talked about my favourite neuro learning resources before

here is an update

do add your suggestions / opinions
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1) neurological exam made easy by geraint fuller

great book - short, readable, nice pictures, clinical

2) neurological differential diagnosis by john patten

brilliant book - the best anatomical drawings of neurology (done by the author), clinical, practical
not so short, but all you will ever need to know about neurological examination (unless you become a neurologist)

3) neuroanatomy through clinical cases by hal blumenfeld

great book - very sensible way to learn neuroanatomy, lots of cases, good pictures, associated website
not short, but very readable

4) neuroanatomy: draw it to know it by adam fisch

great book - teaches anatomy by way of staged diagrams illustrating all the major neuro systems
good text too
not short, but nicely 'chunked'

5) neurologic examination website by university of utah

excellent website - videos of normal & abnormal findings for all major components of neuro exam, downloadable (with permission)

6) the neurological exam website by university of toronto

good site - not as comprehensive as utah site, but well laid out with nice tables
videos only with healthy volunteers

7 eyevideos.blogspot.com

good site made by a young ophthalmologist with videos detailing neuro-ophthalmology examination & investigations

Salaam


s

a 52-year-old woman with tiredness and visual disturbance

yesterday rory presented an interesting case of a middle-aged woman, previously pretty well, who has become increasingly tired over recent weeks


she has also had some blurriness of vision


TIRED ALL THE TIME (TATT)


this is a common complaint but can sometimes be very difficult to diagnose


(also a common OSCE scenario)
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i could not find a specific chapter in davidsons, harrisons or my favourite symptom book tutorials in differential diagnosis (written by eric beck who invented the MRCP exam & is still involved in PDS teaching at he whitt - i was his house officer many years ago; robert souhami was dean of UCL medical school)


in my library the best i could do was a case from an excellent MRCP book (case 2.50 in PACES for MRCP by tim hall)

however, i did find a BBC radio program all about TATT, part of the very good case notes series (with a full transcript available)
_ _ _


we discussed various causes:


- major organ failures (heart, kidneys, liver, lungs)
- endocrine disorders (thyroid, diabetes, also addisons, hypopit)
- cancer
- depression
- anaemia
- auto-immune type disorders (rheumatoid, lupus, GCA, polymyalgia)
- drugs, eg beta-blockers


our patient did not have any features pointing to the specific causes above?
_ _ _


we did not really go through investigations in detail
_ _ _


while we did not examine her, you did go through her pupillary reactions with gordon


she had an afferent pupillary defect [like this one?]

these data point to the possibility of multiple sclerosis

_ _ _

we briefly talked about this mostly relapsing-remitting condition

the diagnosis requires more than one 'attack' in more than one place

the criteria i learnt have now been replaced the the mcdonald criteria which incorporate the advances MRI has brought

rory was going to update us about MS [perhaps as a comment?]

we need to review her investigations, including MR imaging & LP

[tangentially, josiah bartlett, the fictional US president in the west wing, had MS & hid it from the electorate during his first election]

_ _ _

we finished by considering what we would do to learn more

reading a textbook & wikipeding were mentioned

find another patient with MS (soon) is a particularly good strategy

Salaam

sabih