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  <head>
    <title>031-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Neurological history, examination, and localisation">
      <outline text="Orientation and time course">
        <outline text="Where is the lesion, then what process"/>
        <outline text="Coherent localisation guides testing">
          <outline text="Incidental imaging never replaces anatomy"/>
        </outline>
        <outline text="Last-known-normal time for sudden symptoms"/>
        <outline text="Maximal at onset: embolism, bleed, seizure, migraine"/>
        <outline text="Hours to days: inflammation, infection, compression"/>
        <outline text="Weeks to months: tumour, immune, degeneration"/>
        <outline text="Recurrent stereotyped: seizure, migraine, channel"/>
      </outline>
      <outline text="Symptom definition and background">
        <outline text="Ask what failed, not the label">
          <outline text="Dizziness: vertigo, presyncope, imbalance"/>
          <outline text="Weakness: power, pain, fatigue, incoordination"/>
        </outline>
        <outline text="Witness account of episodic events"/>
        <outline text="Vascular risks, cancer, immune, toxins, family"/>
        <outline text="Review anticoagulants, sedatives, dopamine blockers"/>
        <outline text="Baseline mobility, cognition, handedness, wishes"/>
        <outline text="Red flags: thunderclap, meningism, sphincter loss">
          <outline text="Stabilisation precedes complete examination"/>
        </outline>
      </outline>
      <outline text="Mental status">
        <outline text="Arousal and attention first">
          <outline text="Impairment invalidates downstream testing"/>
        </outline>
        <outline text="Memory, language, visuospatial, executive as needed"/>
        <outline text="Scores biased by education, language, culture"/>
        <outline text="Acute fluctuation and inattention suggest delirium"/>
        <outline text="Aphasia versus dysarthria, deafness, low arousal"/>
        <outline text="Capacity judged for the specific decision"/>
      </outline>
      <outline text="Cranial nerves">
        <outline text="Acuity, fields, pupils, fundi, eye movements"/>
        <outline text="Relative afferent defect: asymmetric optic dysfunction"/>
        <outline text="Papilloedema neither immediate nor universal"/>
        <outline text="Upper motor neuron face spares forehead">
          <outline text="Lower motor neuron: whole ipsilateral face"/>
        </outline>
        <outline text="Palate, voice, cough, swallowing safety">
          <outline text="Lower cranial failure threatens airway, nutrition"/>
        </outline>
      </outline>
      <outline text="Motor examination">
        <outline text="Bulk, fasciculation, involuntary movement"/>
        <outline text="Tone at different speeds">
          <outline text="Spasticity velocity-dependent, rigidity uniform"/>
          <outline text="Paratonia varies with cooperation, frontal"/>
        </outline>
        <outline text="True weakness versus pain, fatigue, give-way"/>
        <outline text="Pyramidal: arm extensors, leg flexors weaker"/>
        <outline text="Neuropathy distal, myopathy proximal"/>
        <outline text="Junction weakness fluctuates and fatigues"/>
        <outline text="Hyperreflexia, clonus, extensor plantar: UMN"/>
        <outline text="Reduced reflexes may be a normal variant"/>
      </outline>
      <outline text="Sensory examination">
        <outline text="Map symptoms, eyes closed, avoid rhythm and leading"/>
        <outline text="Cortical tests need primary sensation, attention"/>
        <outline text="Sensory level: spinal cord"/>
        <outline text="Saddle loss: cauda equina or conus"/>
        <outline text="Dermatomal root, named nerve, stocking"/>
        <outline text="Crossed face-body pattern: brainstem"/>
        <outline text="Functional: prefer positive signs to exclusion"/>
      </outline>
      <outline text="Coordination, stance, and gait">
        <outline text="Finger-nose, heel-shin, rapid alternation"/>
        <outline text="Dysmetria may reflect weakness or sensory loss"/>
        <outline text="Romberg: stance without vision">
          <outline text="Eyes-closed falls: proprioceptive or vestibular"/>
        </outline>
        <outline text="Describe gait pattern, not just abnormal"/>
        <outline text="Never test an unsafe patient unassisted"/>
      </outline>
      <outline text="Localisation framework">
        <outline text="Hemisphere: contralateral deficit plus cortical signs"/>
        <outline text="Brainstem: cranial nerve plus contralateral body"/>
        <outline text="Cerebellum: ipsilateral incoordination, no weakness"/>
        <outline text="Cord: bilateral signs below a level">
          <outline text="Segmental LMN at level, UMN below"/>
          <outline text="Hemicord: crossed pain-temperature loss"/>
        </outline>
        <outline text="Cauda equina: asymmetric LMN, saddle, sphincter"/>
        <outline text="Root: radiating pain, myotome, dermatome, reflex"/>
        <outline text="Junction and myopathy spare sensation"/>
      </outline>
      <outline text="Investigations">
        <outline text="CT: blood, mass effect, hydrocephalus, fracture"/>
        <outline text="MRI: infarct, demyelination, posterior fossa, cord"/>
        <outline text="Urgency follows clinical risk"/>
        <outline text="Incidental findings common, correlate with exam"/>
        <outline text="Lumbar puncture: pressure, cells, protein, glucose">
          <outline text="Image first if herniation risk suspected"/>
          <outline text="Do not delay antimicrobials"/>
        </outline>
        <outline text="Short normal EEG does not exclude epilepsy"/>
        <outline text="Nerve conduction: axonal versus demyelinating"/>
      </outline>
      <outline text="Integration and communication">
        <outline text="One sentence: syndrome, site, mechanism, tempo"/>
        <outline text="State uncertainty, repeat examination"/>
        <outline text="Driving, water safety, falls, swallowing"/>
        <outline text="Functional disorder by positive signs"/>
        <outline text="Rehabilitation begins alongside diagnosis"/>
      </outline>
    </outline>
  </body>
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