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  <head>
    <title>030-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Stroke, seizure, neuropathy, neurodegeneration, pressure">
      <outline text="Orientation by anatomy, mechanism, time">
        <outline text="Sudden focal deficit: vascular until proven otherwise"/>
        <outline text="Episodic stereotyped: seizure or transient disturbance"/>
        <outline text="Progressive: degeneration, tumour, inflammation, compression"/>
        <outline text="Localise and stabilise together">
          <outline text="Definitive treatment depends on minutes"/>
        </outline>
      </outline>
      <outline text="Cerebral ischaemia">
        <outline text="Needs continuous oxygen and glucose, stores little"/>
        <outline text="Occlusion: irreversible core, hypoperfused penumbra">
          <outline text="Penumbra may recover if flow returns"/>
        </outline>
        <outline text="Glutamate, calcium, radicals, mitochondria expand injury"/>
        <outline text="Collaterals, site, pressure, glucose, time decide survival"/>
        <outline text="Transient ischaemic attack: no established infarction">
          <outline text="Early stroke risk can be high"/>
        </outline>
        <outline text="Anterior: contralateral weakness and sensory loss">
          <outline text="Dominant: aphasia; non-dominant: neglect"/>
        </outline>
        <outline text="Posterior: diplopia, dysarthria, ataxia, crossed signs"/>
        <outline text="Isolated dizziness usually not stroke">
          <outline text="Severe persistent vestibular syndrome, central signs"/>
        </outline>
      </outline>
      <outline text="Acute stroke treatment">
        <outline text="Record last known well, anticoagulants, baseline"/>
        <outline text="Non-contrast computed tomography: haemorrhage, mimics">
          <outline text="Normal early scan does not exclude ischaemia"/>
        </outline>
        <outline text="Vascular imaging finds treatable occlusion"/>
        <outline text="Diffusion imaging sensitive but must not delay treatment"/>
        <outline text="Intravenous thrombolysis within validated window"/>
        <outline text="Thrombectomy for selected large-vessel occlusion">
          <outline text="Later presenters if tissue is salvageable"/>
        </outline>
        <outline text="Rapid pressure reduction can cut penumbral flow"/>
        <outline text="Decompression for malignant hemispheric, cerebellar"/>
        <outline text="Secondary prevention targets mechanism"/>
      </outline>
      <outline text="Intracranial haemorrhage">
        <outline text="Intracerebral: disruption, mass effect, oedema">
          <outline text="Sometimes ventricular obstruction"/>
        </outline>
        <outline text="Hypertension, amyloid angiopathy, anticoagulation"/>
        <outline text="Routine seizure prophylaxis not universally helpful"/>
        <outline text="Subarachnoid: sudden maximal headache">
          <outline text="Rebleeding, vasospasm, hydrocephalus, sodium"/>
        </outline>
        <outline text="Non-diagnostic imaging needs further testing"/>
        <outline text="Secure aneurysm early, give nimodipine"/>
      </outline>
      <outline text="Seizures and epilepsy">
        <outline text="Transient excessive or synchronous neuronal activity"/>
        <outline text="Focal: one hemisphere, impaired awareness, spread"/>
        <outline text="Generalised: bilateral networks from onset"/>
        <outline text="Epilepsy: enduring predisposition to unprovoked seizures"/>
        <outline text="Normal electroencephalogram does not exclude epilepsy"/>
        <outline text="Protect, airway, glucose, no restraint"/>
        <outline text="Status: about five minutes or no recovery">
          <outline text="Benzodiazepine, then longer-acting drug"/>
          <outline text="Persistent coma: non-convulsive status, EEG"/>
        </outline>
        <outline text="Safety: driving, water, work, pregnancy planning"/>
        <outline text="Refractory focal: surgery, stimulation, diet"/>
      </outline>
      <outline text="Raised intracranial pressure">
        <outline text="Rigid skull: brain, blood, cerebrospinal fluid"/>
        <outline text="Reserve exhausted, pressure rises sharply"/>
        <outline text="Perfusion pressure: mean arterial minus intracranial"/>
        <outline text="Headache, vomiting, sixth-nerve palsy, papilloedema">
          <outline text="Papilloedema may be absent acutely"/>
        </outline>
        <outline text="Hypertension, bradycardia, irregular breathing: late"/>
        <outline text="Elevate head, avoid hypotonic fluid, treat fever"/>
        <outline text="Hypertonic saline or mannitol reduce swelling briefly"/>
        <outline text="Brief hyperventilation: rescue bridge only"/>
        <outline text="Lumbar puncture dangerous with pressure gradients"/>
      </outline>
      <outline text="Infection and inflammation">
        <outline text="Meningitis: fever, headache, neck stiffness, rash">
          <outline text="Classic combinations may be incomplete"/>
        </outline>
        <outline text="Cultures and empirical antimicrobials without delay"/>
        <outline text="Autoimmune encephalitis: subacute memory, psychiatric"/>
        <outline text="Multiple sclerosis: dissemination in time and space">
          <outline text="Optic neuritis, brainstem syndromes, myelitis"/>
        </outline>
        <outline text="Steroids for relapse, disease-modifying therapy"/>
      </outline>
      <outline text="Peripheral neuropathy">
        <outline text="Distribution, fibre type, pathology, tempo"/>
        <outline text="Length-dependent: feet before hands"/>
        <outline text="Small fibre: burning pain, autonomic, normal studies"/>
        <outline text="Large fibre: vibration, proprioception, reflexes"/>
        <outline text="Conduction studies: axonal loss versus demyelination"/>
        <outline text="Guillain-Barre: rapid weakness, areflexia">
          <outline text="Monitor vital capacity, swallowing, rhythm"/>
          <outline text="Immunoglobulin or plasma exchange modifies disease"/>
          <outline text="Corticosteroids alone do not"/>
        </outline>
      </outline>
      <outline text="Neurodegeneration">
        <outline text="Alzheimer: episodic memory, amyloid and tau"/>
        <outline text="Lewy body: fluctuation, hallucinations, parkinsonism"/>
        <outline text="Frontotemporal: behaviour, executive, language"/>
        <outline text="Parkinson: dopaminergic and wider networks"/>
        <outline text="Motor neuron: upper and lower loss, sensation spared"/>
        <outline text="Consider reversible contributors"/>
        <outline text="Respect capacity, autonomy, personal goals"/>
      </outline>
    </outline>
  </body>
</opml>
