CENTRAL NERVOUS SYSTEM (CNS)
High-Yield Neurology Notes for Exams, OSCEs & Clinical Revision
Course: Neurology / Medicine / Nursing / Health Sciences
Document type: Comprehensive exam-focused lecture summary with clinical correlations
COMMON NEUROLOGICAL SYMPTOMS (FREQUENTLY TESTED)
Headache
Headache is a common neurological complaint and is usually benign. It results from activation of primary
afferent fibres innervating cephalic blood vessels, particularly meningeal and cerebral vessels.
Primary headache disorders: - Migraine - Cluster headache - Tension-type headache
Red flags (require urgent imaging – CT/MRI): - Progressively worsening headache - Sudden severe “worst-
ever” headache (suggests subarachnoid haemorrhage) - Headache with neck stiffness (meningitis or SAH) -
Headache in elderly with generalized pain (giant cell arteritis)
GAIT ABNORMALITIES (EXAM FAVORITE)
Spastic Gait (UMN lesion)
• Stiff, slow gait
• Narrow base
• Circumduction in hemiparesis
Parkinsonian Gait
• Stooped posture
• Reduced arm swing
• Shuffling, festinant gait
• Freezing episodes
Cerebellar Ataxia
• Broad-based gait
• Veering toward affected side
• Truncal ataxia with vermis lesions
1
, Sensory Ataxia
• High-stepping, stamping gait
• Worse with eyes closed (positive Romberg)
Waddling Gait
• Proximal muscle weakness
• Seen in muscular dystrophy and polymyositis
DIZZINESS, SYNCOPE & SEIZURES
Syncope
• Brief loss of consciousness due to reduced cerebral perfusion
• Rapid recovery
• Often confused with epilepsy
Vertigo
• Sensation of spinning
• Caused by vestibular system pathology
Key Investigations
• History and eyewitness account
• ECG
• Blood pressure (lying and standing)
• Tilt-table testing if unexplained
MUSCLE WEAKNESS: LOCALIZATION
Weakness may arise from lesions at different levels: - Motor cortex - Corticospinal tract - Anterior horn cell -
Peripheral nerve - Neuromuscular junction - Muscle
Upper Motor Neurone (UMN) Lesions
• Increased tone
• Hyperreflexia
• Extensor plantar response
Lower Motor Neurone (LMN) Lesions
• Muscle wasting
• Fasciculations
2
High-Yield Neurology Notes for Exams, OSCEs & Clinical Revision
Course: Neurology / Medicine / Nursing / Health Sciences
Document type: Comprehensive exam-focused lecture summary with clinical correlations
COMMON NEUROLOGICAL SYMPTOMS (FREQUENTLY TESTED)
Headache
Headache is a common neurological complaint and is usually benign. It results from activation of primary
afferent fibres innervating cephalic blood vessels, particularly meningeal and cerebral vessels.
Primary headache disorders: - Migraine - Cluster headache - Tension-type headache
Red flags (require urgent imaging – CT/MRI): - Progressively worsening headache - Sudden severe “worst-
ever” headache (suggests subarachnoid haemorrhage) - Headache with neck stiffness (meningitis or SAH) -
Headache in elderly with generalized pain (giant cell arteritis)
GAIT ABNORMALITIES (EXAM FAVORITE)
Spastic Gait (UMN lesion)
• Stiff, slow gait
• Narrow base
• Circumduction in hemiparesis
Parkinsonian Gait
• Stooped posture
• Reduced arm swing
• Shuffling, festinant gait
• Freezing episodes
Cerebellar Ataxia
• Broad-based gait
• Veering toward affected side
• Truncal ataxia with vermis lesions
1
, Sensory Ataxia
• High-stepping, stamping gait
• Worse with eyes closed (positive Romberg)
Waddling Gait
• Proximal muscle weakness
• Seen in muscular dystrophy and polymyositis
DIZZINESS, SYNCOPE & SEIZURES
Syncope
• Brief loss of consciousness due to reduced cerebral perfusion
• Rapid recovery
• Often confused with epilepsy
Vertigo
• Sensation of spinning
• Caused by vestibular system pathology
Key Investigations
• History and eyewitness account
• ECG
• Blood pressure (lying and standing)
• Tilt-table testing if unexplained
MUSCLE WEAKNESS: LOCALIZATION
Weakness may arise from lesions at different levels: - Motor cortex - Corticospinal tract - Anterior horn cell -
Peripheral nerve - Neuromuscular junction - Muscle
Upper Motor Neurone (UMN) Lesions
• Increased tone
• Hyperreflexia
• Extensor plantar response
Lower Motor Neurone (LMN) Lesions
• Muscle wasting
• Fasciculations
2
