Neurology and Neurosurgery

Canonical Reading Material for the Exam Candidate
The unavoidable reading material for this topic includes the following textbook chapters and papers: Oh's Intensive Care manual: Chapter 49 (pp. 549) Disorders of consciousness by Balasubramanian Venkatesh Chapter 50 (pp. 560) Status epilepticus by Helen I Opdam Chapter 51 (pp. 568) Acute cerebrovascular complications by Bernard Riley and Thearina de Beer Chapter 52 (pp. 580) Cerebral protection by Victoria Heaviside and Michelle Hayes Chapter 53 (pp. 591) Brain death by Martin Smith Chapter 57 (pp. 617) Neuromuscular diseases in intensive care by George Skowronski and Manoj K Saxena Chapter 78 (pp. 795) Spinal injuries by Sumesh Arora and Oliver J Flower Reading the Brain Trauma Foundation guidelines is also unavoidable. Walker and O'Brien's 1990 paper "Neurological examination of the unconscious patient" is an excellent brief synopsis; it draws its inspiration from the 1980 edition of Plum and Posner's "The Diagnosis of Stupor and Coma", which is essentially the Old Testament for neurological examination of the critically ill. The time-poor candidate will probably be unable to make use of this textbook, but the paper needs to be read through at least once before the exam. The hypothetical exam candidate with infinite time resources may also benefit from exploring The Comatose Patient by Eelco Wijdicks (2014). Summaries and discussions of neurological and neurosurgical topics from Life in the Fast Lane are made available as a list of links in the Resources section.

Intracranial Pressure and Cerebral Perfusion
Methods of intracranial pressure monitoring
Indications for intracranial pressure monitoring
Cerebral metabolic demand
Interpretation of intracranial pressure waveforms
Correlation of ICP waveforms with intracranial pathology

Traumatic Brain Injury
A summary of the Brain Trauma Foundation guidelines
Prevention of secondary brain injury: "Neuroprotective Measures"
Management of raised intracranial pressure
Osmotherapy for management of raised intracranial pressure
Intracranial pressure as a therapeutic target
Cerebral perfusion pressure as a therapeutic target
Post-traumatic seizures, their prevention and management
Prognosis in severe brain injury
Brain herniation
Decompressive craniectomy for traumatic brain injury
Therapeutic and prophylactic hypothermia for traumatic brain injury
Limitations of CT in assessment of traumatic brain injury
Polyuria following traumatic brain injury
Cerebral salt wasting syndrome
Haemodialysis in patients with traumatic brain injury
Concussion and unconsciousness following head injury

Ischaemic and Haemorrhagic Stroke
Causes and classifications of stroke
Classical stroke syndromes
Endovascular clot retrieval for early ischaemic stroke
Acute supportive management for stroke in the ICU
Decompressive craniectomy for malignant MCA infarction
Arguments against ICU admission for comatose stroke patients
Thrombolysis for early ischaemic stroke
Factors which influence prognosis of intracranial haemorrhage
Cerebral venous sinus thrombosis

Subarachnoid Haemorrhage
Risk factors for subarachnoid haemorrhage
Grading of subarachnoid haemorrhage severity
Monitoring for vasospasm following SAH
Prevention and management of vasospasm following SAH
Evidence for the use of nimodipine in SAH
Non-vasospasm complications of SAH
Management of the unsecured aneurysm in subarachnoid haemorrhage

Approach to the Patient with Weakness
Sustained neuromuscular junction blockade in critical illness
Approach to the ICU patient with generalised weakness
Features that distinguish myopathy from neuropathy
Intensive Care for Guillain-Barre Syndrome
ICU-acquired weakness
Distinguishing features of lower motor neuron syndromes

Spinal Injury and Lesions of the Peripheral Nervous System
Management of acute high spinal injury
Physiological consequences of spinal cord transection
Clearance of the C-spine in the unconscious patient
Important spinal cord injury syndromes
Eponymous spinal fractures
The dermatomes
Brachial plexus: anatomical course and lesions
Ulnar nerve: anatomical course and lesions
Median nerve: anatomical course and lesions
Radial nerve: anatomical course and lesions

Status Epilepticus and Management of Seizures
Management of Status Epilepticus in ICU
Non-convulsive status epilepticus
Relationship of seizure duration and neurological outcome
Extracranial consequences of status epilepticus
Causes of status epilepticus
Features that discriminate "true" seizures from pseudoseizures

Neurological Examination and Investigations
The Glasgow Coma Scale in the assessment of consciousness
Approach to the unconscious patient in the ICU
States of persistent unconsciousness
Causes of neck stiffness
Assessment of swallowing function in a critically ill patient
Physical signs of cerebellar disease
Properties and contents of cerebrospinal fluid
The utility of the EEG in the ICU
The utility of SSEPs in the ICU

Cranial Nerve Examination in the Critically Ill Patient
Examination of the cranial nerves
Examination and lesions of the olfactory nerve (CN I)
Examination of visual acuity and blindness (CN II)
Fundoscopy: characteristic findings (CN II)
Examination of pupil reactivity and diameter (CN II, III)
Visual fields and lesions of the visual pathways (CN II)
Examination of eye movements (CN III, IV, VI)
Lesions of the oculomotor nerve (CN III)
Lesions of the trochlear nerve (CN IV)
Lesions of the abducens nerve (CN VI)
Disorders of conjugate gaze
Lesions of the trigeminal nerve (CN V)
Lesions of the facial nerve (CN VII)
Corneal reflex (CN V, VII)
Oculocephalic and cold caloric reflexes (CN III, IV, VI and VIII)
Lesions of the vestibulocochlear nerve (CN VIII)
Lesions of the glossopharyngeal and vagus nerves (CN IX and X)
Lesions of the accessory nerve (CN XI)
Lesions of the hypoglossal nerve (CN XII)
Horner's Syndrome

Neuromiscellanea
The Significance of Hiccups
Thromboprophylaxis in neurosurgical patients
Posterior reversible leukoencephalopathy syndrome (PRES)
Pneumocephalus
Cerebral oedema
Encephalitis

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