mkdir -p /home/daytona/workspace/neuro-nursing-pdf && ls /home/daytona/workspace…

~/neuro-nursing-pdf/generate_pdf.py

from reportlab.lib.pagesizes import A4
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm
from reportlab.lib import colors
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, PageBreak,
    HRFlowable, Table, TableStyle, KeepTogether
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY

OUTPUT = "/home/daytona/workspace/neuro-nursing-pdf/Nursing_Management_Neurological_Disorders.pdf"

# ── Colour palette ──────────────────────────────────────────────
NAVY   = colors.HexColor("#1B3A6B")
TEAL   = colors.HexColor("#1A7A8A")
GOLD   = colors.HexColor("#D4A017")
LGRAY  = colors.HexColor("#F4F6F9")
MGRAY  = colors.HexColor("#CCCCCC")
WHITE  = colors.white
BLACK  = colors.black

# ── Styles ───────────────────────────────────────────────────────
styles = getSampleStyleSheet()

cover_title = ParagraphStyle("cover_title", fontSize=28, leading=36,
    textColor=WHITE, alignment=TA_CENTER, fontName="Helvetica-Bold")
cover_sub   = ParagraphStyle("cover_sub", fontSize=16, leading=22,
    textColor=GOLD, alignment=TA_CENTER, fontName="Helvetica-Bold")
cover_body  = ParagraphStyle("cover_body", fontSize=12, leading=18,
    textColor=WHITE, alignment=TA_CENTER, fontName="Helvetica")

h1 = ParagraphStyle("h1", fontSize=20, leading=26, textColor=WHITE,
    fontName="Helvetica-Bold", alignment=TA_LEFT,
    spaceBefore=6, spaceAfter=4)

h2 = ParagraphStyle("h2", fontSize=13, leading=18, textColor=NAVY,
    fontName="Helvetica-Bold", spaceBefore=10, spaceAfter=4,
    borderPad=4)

body = ParagraphStyle("body", fontSize=10, leading=15, textColor=BLACK,
    fontName="Helvetica", alignment=TA_JUSTIFY,
    spaceBefore=2, spaceAfter=4)

bullet = ParagraphStyle("bullet", fontSize=10, leading=14,
    textColor=BLACK, fontName="Helvetica",
    leftIndent=18, bulletIndent=6, spaceBefore=1)

toc_style = ParagraphStyle("toc", fontSize=11, leading=18,
    textColor=NAVY, fontName="Helvetica", leftIndent=10)

# ── Helper functions ─────────────────────────────────────────────
def section_header(title, color=NAVY):
    """Full-width coloured banner for a topic heading."""
    data = [[Paragraph(title, h1)]]
    t = Table(data, colWidths=[17*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), color),
        ("TOPPADDING",    (0,0), (-1,-1), 8),
        ("BOTTOMPADDING", (0,0), (-1,-1), 8),
        ("LEFTPADDING",   (0,0), (-1,-1), 12),
        ("RIGHTPADDING",  (0,0), (-1,-1), 12),
        ("ROUNDEDCORNERS", [6]),
    ]))
    return t

def sub_header(text):
    data = [[Paragraph(text, h2)]]
    t = Table(data, colWidths=[17*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), LGRAY),
        ("TOPPADDING",    (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING",   (0,0), (-1,-1), 10),
        ("BOTTOMLINE", (0,-1), (-1,-1), 1.5, TEAL),
    ]))
    return t

def p(text):
    return Paragraph(text, body)

def bp(text):
    return Paragraph(f"<bullet>&bull;</bullet> {text}", bullet)

def sp(n=6):
    return Spacer(1, n)

def hr():
    return HRFlowable(width="100%", thickness=0.5, color=MGRAY, spaceAfter=4)

def topic_block(title, sections_dict, color=NAVY):
    """Returns a list of flowables for one complete topic."""
    elems = [PageBreak(), section_header(title, color), sp(8)]
    for sec_title, content in sections_dict.items():
        elems.append(sub_header(sec_title))
        elems.append(sp(3))
        if isinstance(content, list):
            for item in content:
                if item.startswith("__"):           # sub-bullet level
                    elems.append(Paragraph(f"<bullet>   &#x25E6;</bullet> {item[2:]}", bullet))
                else:
                    elems.append(bp(item))
        else:
            elems.append(p(content))
        elems.append(sp(6))
    return elems

# ════════════════════════════════════════════════════════════════
#  TOPIC DATA
# ════════════════════════════════════════════════════════════════

topics = []

# ── 1. HEADACHE ─────────────────────────────────────────────────
topics.append(("1. Headache", {
    "Definition": ["Headache is pain or discomfort in the head, scalp, or neck. It is one of the most common neurological complaints encountered in clinical practice. It may be primary (no identifiable cause) or secondary (due to an underlying condition)."],
    "Types": [
        "Primary Headaches:",
        "__Tension-type headache (TTH) - bilateral, pressing/tightening quality",
        "__Migraine - unilateral, pulsating, moderate-severe, with nausea/photophobia",
        "__Cluster headache - severe unilateral orbital/periorbital, occurring in clusters",
        "__New Daily Persistent Headache (NDPH)",
        "Secondary Headaches:",
        "__Caused by intracranial pathology (tumour, haemorrhage, meningitis)",
        "__Medication-overuse headache",
        "__Cervicogenic headache",
    ],
    "Etiology": [
        "Tension: stress, poor posture, anxiety, eye strain, muscle tension",
        "Migraine: genetic predisposition, hormonal changes, dietary triggers (cheese, wine, caffeine), sleep disruption, sensory stimuli",
        "Cluster: hypothalamic dysfunction, alcohol, cigarette smoking",
        "Secondary: hypertension, intracranial haemorrhage, meningitis, brain tumour, sinusitis, trauma",
    ],
    "Pathophysiology": [
        "Tension: sustained muscle contraction of pericranial muscles + central sensitisation of pain pathways",
        "Migraine: cortical spreading depression (CSD) activates trigeminovascular pathway → release of CGRP and substance P → neurogenic inflammation → pain",
        "Cluster: activation of posterior hypothalamus → trigeminal-autonomic reflex → vasodilation and parasympathetic activation",
    ],
    "Clinical Manifestations": [
        "Tension: bilateral band-like pressure, mild-moderate, no nausea, not aggravated by activity",
        "Migraine: unilateral throbbing pain, nausea, vomiting, photophobia, phonophobia; may have aura (visual scotoma, zigzag lines)",
        "Cluster: excruciating unilateral periorbital pain, lacrimation, rhinorrhoea, ptosis, miosis, restlessness",
        "Red flags (secondary): thunderclap onset, focal neuro deficits, fever+neck stiffness, papilloedema, progressive worsening",
    ],
    "Diagnosis": [
        "History: onset, character, location, duration, frequency, associated symptoms, triggers",
        "Neurological examination",
        "CT scan / MRI brain: to rule out secondary causes",
        "Lumbar puncture: if subarachnoid haemorrhage suspected",
        "Blood tests: CBC, ESR (temporal arteritis), electrolytes",
    ],
    "Management": [
        "Tension: NSAIDs, paracetamol; prophylaxis with amitriptyline; stress management, physiotherapy",
        "Migraine acute: triptans (sumatriptan), NSAIDs, antiemetics (metoclopramide); rest in dark quiet room",
        "Migraine prophylaxis: propranolol, topiramate, valproate, amitriptyline",
        "Cluster: 100% O2 (7-10 L/min), sumatriptan SC; prophylaxis with verapamil",
        "Nursing: monitor pain level, administer medications as ordered, reduce environmental stimuli, teach trigger avoidance",
    ],
}))

# ── 2. HEAD INJURIES ────────────────────────────────────────────
topics.append(("2. Head Injuries", {
    "Definition": ["Head injury refers to any trauma to the scalp, skull, or brain. Traumatic brain injury (TBI) is a disruption in normal brain function caused by external mechanical force."],
    "Types": [
        "Based on mechanism: Open (penetrating) vs Closed (blunt)",
        "Based on severity: Mild (GCS 13-15), Moderate (GCS 9-12), Severe (GCS ≤ 8)",
        "Scalp injuries: lacerations, haematomas",
        "Skull fractures: linear, depressed, basilar",
        "Brain injuries:",
        "__Concussion - transient neurological dysfunction, no structural damage",
        "__Contusion - bruising of brain parenchyma",
        "__Diffuse axonal injury (DAI) - widespread shearing of axons",
        "__Intracranial haematoma: Epidural (EDH), Subdural (SDH), Intracerebral (ICH)",
    ],
    "Etiology": [
        "Road traffic accidents (most common)",
        "Falls (especially elderly)",
        "Assault / violence",
        "Sports injuries",
        "Blast injuries (military)",
    ],
    "Pathophysiology": [
        "Primary injury: direct mechanical damage at time of impact - contusion, laceration, haemorrhage, DAI",
        "Secondary injury: delayed cascade - cerebral oedema, raised ICP, ischaemia, excitotoxicity (glutamate release), inflammation, herniation",
        "Raised ICP compresses brainstem → Cushing's triad (hypertension, bradycardia, irregular respirations)",
        "Epidural haematoma: rupture of middle meningeal artery → arterial bleed between dura and skull → lucid interval then rapid deterioration",
        "Subdural haematoma: tearing of bridging veins → venous bleed between dura and arachnoid",
    ],
    "Clinical Manifestations": [
        "Loss of consciousness (LOC), amnesia",
        "Headache, vomiting",
        "Altered GCS",
        "Focal neurological deficits (hemiplegia, speech problems)",
        "Pupillary changes: ipsilateral fixed dilated pupil (herniation)",
        "Cushing's triad: hypertension, bradycardia, irregular breathing",
        "Battle's sign (mastoid bruising), raccoon eyes, haemotympanum (basilar fracture)",
        "CSF otorrhoea/rhinorrhoea",
        "Seizures",
    ],
    "Diagnosis": [
        "GCS assessment",
        "CT scan head (investigation of choice): identifies haematomas, fractures, oedema",
        "MRI brain: better for DAI, posterior fossa injuries",
        "Skull X-ray: fractures",
        "ICP monitoring (severe TBI)",
        "Blood: CBC, coagulation studies, ABG",
    ],
    "Management": [
        "Airway, Breathing, Circulation (ABC) - primary survey",
        "Cervical spine immobilisation",
        "Maintain O2 saturation > 95%, avoid hypotension (SBP > 90 mmHg)",
        "ICP management: head elevation 30°, osmotherapy (mannitol 20%, hypertonic saline), hyperventilation (temporary)",
        "Surgical: evacuation of haematoma (craniotomy/burr holes)",
        "Seizure prophylaxis: phenytoin/levetiracetam",
        "Nursing: hourly neuro observations (GCS, pupils), strict I&O, DVT prophylaxis, wound care, rehabilitation",
        "Mild TBI: observe, analgesia, education on red flags, follow-up",
    ],
}))

# ── 3. SPINAL INJURIES ──────────────────────────────────────────
topics.append(("3. Spinal Injuries: Paraplegia, Hemiplegia, Quadriplegia", {
    "Definition": [
        "Spinal cord injury (SCI): damage to the spinal cord resulting in loss of motor, sensory, and autonomic function below the level of injury.",
        "Paraplegia: paralysis of both lower limbs (thoracic/lumbar injury)",
        "Hemiplegia: paralysis of one side of the body (usually cerebral/cervical injury)",
        "Quadriplegia (Tetraplegia): paralysis of all four limbs (cervical cord injury C1-C7)",
    ],
    "Types": [
        "Complete SCI: total loss of motor and sensory function below injury level (ASIA A)",
        "Incomplete SCI: partial preservation of function (ASIA B-D):",
        "__Central cord syndrome: arms weaker than legs; bladder dysfunction",
        "__Brown-Sequard syndrome: ipsilateral motor loss + contralateral pain/temp loss",
        "__Anterior cord syndrome: bilateral motor loss + pain/temp loss; preserved proprioception",
        "__Conus medullaris syndrome: LMN + UMN features",
        "__Cauda equina syndrome: LMN lesion, saddle anaesthesia, bladder/bowel dysfunction",
    ],
    "Etiology": [
        "Trauma: MVA (most common), falls, sports, violence, diving accidents",
        "Non-traumatic: tumours, infection (epidural abscess), vascular (AVM), transverse myelitis, spondylosis",
    ],
    "Pathophysiology": [
        "Primary injury: mechanical disruption of axons, blood vessels, cell membranes",
        "Secondary injury: haemorrhage, oedema, ischaemia, excitotoxicity, inflammation, apoptosis",
        "Spinal shock: immediately after injury - flaccid paralysis, areflexia, loss of autonomic control below lesion",
        "Spinal shock resolves over 4-6 weeks → spasticity, hyperreflexia emerge (UMN lesion pattern)",
        "Autonomic dysreflexia: life-threatening hypertensive crisis in injuries above T6 - triggered by noxious stimuli below level",
    ],
    "Clinical Manifestations": [
        "Loss of voluntary motor function below injury level",
        "Loss of sensation (pain, temperature, touch, proprioception)",
        "Flaccid paralysis acutely → spasticity later (UMN)",
        "Bladder/bowel dysfunction (neurogenic bladder/bowel)",
        "Sexual dysfunction",
        "Respiratory compromise (C3-C5 affects diaphragm - may need ventilator)",
        "Autonomic dysreflexia (T6 and above): sudden severe hypertension, pounding headache, flushing above lesion, sweating, bradycardia",
        "Pressure ulcers, DVT, orthostatic hypotension",
    ],
    "Diagnosis": [
        "ASIA impairment scale assessment",
        "CT spine: fractures, alignment",
        "MRI spine: cord compression, haemorrhage, disc herniation",
        "Plain X-rays: initial screening",
        "Urodynamic studies, electromyography",
    ],
    "Management": [
        "Acute: immobilisation (cervical collar/spinal board), airway management",
        "High-dose methylprednisolone (controversial - within 8 hours of injury)",
        "Surgical decompression and stabilisation",
        "Bladder: intermittent catheterisation, suprapubic catheter",
        "Bowel: bowel training program, stool softeners",
        "Autonomic dysreflexia: sit patient upright, identify and remove trigger (kinked catheter, full bowel), antihypertensives (nifedipine, nitrates)",
        "Rehabilitation: physiotherapy, occupational therapy, psychological support",
        "Nursing: pressure area care (2-hourly turns), DVT prophylaxis, respiratory exercises, passive ROM exercises",
    ],
}))

# ── 4. SPINAL CORD COMPRESSION / DISC HERNIATION ────────────────
topics.append(("4. Spinal Cord Compression: Herniation of Intervertebral Disc", {
    "Definition": ["Spinal cord compression occurs when any lesion exerts pressure on the spinal cord or nerve roots, impairing neurological function. Intervertebral disc herniation (prolapsed disc) is the protrusion of the nucleus pulposus through a tear in the annulus fibrosus, compressing adjacent neural structures."],
    "Types": [
        "Disc herniation levels: cervical (C5-C6, C6-C7 most common), lumbar (L4-L5, L5-S1 most common), thoracic (rare)",
        "Protrusion: nucleus bulges but annulus intact",
        "Extrusion: nucleus breaks through annulus",
        "Sequestration: free fragment in spinal canal",
        "Causes of cord compression: disc herniation, tumour, abscess, haematoma, spondylosis, fracture",
    ],
    "Etiology": [
        "Degenerative disc disease (most common)",
        "Age-related loss of disc hydration and elasticity",
        "Repetitive microtrauma, heavy lifting, poor posture",
        "Acute trauma",
        "Obesity",
        "Genetic predisposition to disc disease",
    ],
    "Pathophysiology": [
        "Annulus fibrosus tears with age/trauma → nucleus pulposus herniates posterolaterally",
        "Herniated disc compresses nerve root (radiculopathy) or spinal cord (myelopathy)",
        "Inflammatory mediators (phospholipase A2, TNF-α) released from disc → nerve root inflammation and pain",
        "Chronic compression → demyelination, axonal loss, gliosis",
        "Lumbar stenosis: degenerative changes narrow spinal canal → neurogenic claudication",
    ],
    "Clinical Manifestations": [
        "Neck/back pain radiating along dermatomal distribution (radiculopathy)",
        "Cervical: pain/numbness/tingling in arm, weakness in hand",
        "Lumbar: sciatica - shooting pain down leg, below knee",
        "Positive straight leg raise (SLR) test: lumbar disc",
        "Myelopathy (cord compression): spastic paraparesis, sensory level, bladder/bowel dysfunction",
        "Cauda equina syndrome (emergency): bilateral leg weakness, saddle anaesthesia, urinary retention/incontinence",
        "Lhermitte's sign (cervical myelopathy): electric shock sensation on neck flexion",
    ],
    "Diagnosis": [
        "MRI spine (gold standard): disc herniation level, cord/root compression",
        "CT myelography: alternative if MRI contraindicated",
        "Plain X-ray: alignment, degenerative changes, disc space narrowing",
        "EMG/NCS: radiculopathy, nerve root dysfunction",
        "Clinical: dermatomal sensory loss, reflex changes, motor weakness",
    ],
    "Management": [
        "Conservative (most cases resolve in 6-12 weeks):",
        "__Analgesia: NSAIDs, paracetamol, muscle relaxants, gabapentin/pregabalin (neuropathic)",
        "__Physiotherapy: core strengthening, traction, heat/cold therapy",
        "__Epidural steroid injections",
        "Surgical indications: progressive neuro deficit, cauda equina syndrome, failed conservative treatment >6 weeks",
        "__Microdiscectomy / laminectomy",
        "__Anterior cervical discectomy and fusion (ACDF)",
        "Nursing: pain management, positioning (log-rolling), bowel/bladder monitoring, deep breathing, mobilisation when permitted",
    ],
}))

# ── 5. INTRACRANIAL & CEREBRAL ANEURYSMS ────────────────────────
topics.append(("5. Intracranial Pressure & Cerebral Aneurysms", {
    "Definition": [
        "Raised Intracranial Pressure (RICP): ICP > 15 mmHg (normal 7-15 mmHg). The Monro-Kellie doctrine states that total volume within the rigid skull (brain + blood + CSF) is constant; an increase in any component raises ICP.",
        "Cerebral Aneurysm: an abnormal saccular dilation of a cerebral artery wall, most commonly at arterial bifurcations in the Circle of Willis. Rupture causes subarachnoid haemorrhage (SAH).",
    ],
    "Types": [
        "ICP causes: traumatic oedema, haematoma, hydrocephalus, tumour, meningitis, hypertensive encephalopathy",
        "Cerebral herniation syndromes:",
        "__Uncal (transtentorial): CN III palsy, contralateral hemiplegia",
        "__Tonsillar: brainstem compression, death",
        "Aneurysm types: saccular/berry (90%), fusiform, mycotic (infectious)",
        "Common locations: anterior communicating artery (30%), posterior communicating artery (25%), MCA bifurcation (20%)",
    ],
    "Etiology": [
        "RICP: head trauma, stroke, tumour, meningitis, pseudotumour cerebri, hydrocephalus",
        "Aneurysm: congenital vessel wall weakness, hypertension, atherosclerosis, polycystic kidney disease (ADPKD), connective tissue disorders (Marfan's, Ehlers-Danlos), smoking, cocaine use",
    ],
    "Pathophysiology": [
        "RICP: cerebral perfusion pressure (CPP) = MAP - ICP; as ICP rises, CPP falls → ischaemia",
        "Autoregulation maintained until ICP >30 mmHg; beyond this, CPP falls steeply",
        "Cerebral oedema: vasogenic (BBB breakdown), cytotoxic (cell swelling after ischaemia)",
        "Aneurysm: haemodynamic stress at bifurcations → intimal degeneration → sac formation",
        "SAH: rupture floods subarachnoid space → sudden ICP rise, vasospasm (3-14 days), hydrocephalus, cerebral ischaemia",
    ],
    "Clinical Manifestations": [
        "RICP: headache (worse in morning, on bending), vomiting, visual disturbances, papilloedema",
        "Severe RICP: Cushing's triad, altered consciousness, herniation signs",
        "Unruptured aneurysm: often silent; occasionally: CN III palsy (posterior communicating artery), visual loss",
        "SAH (ruptured aneurysm): thunderclap headache ('worst headache of my life'), meningism (neck stiffness, Kernig's/Brudzinski's signs), photophobia, vomiting, loss of consciousness",
        "Graded by Hunt and Hess scale (I-V) or WFNS scale",
    ],
    "Diagnosis": [
        "RICP: CT head, ICP monitoring (EVD, parenchymal probe), fundoscopy (papilloedema)",
        "SAH: CT head (blood in basal cisterns, sulci) - 98% sensitive in first 12 hours",
        "LP: xanthochromia if CT negative and SAH suspected (>12 hours after onset)",
        "CT angiography / MR angiography / Digital subtraction angiography (DSA - gold standard): aneurysm location and size",
    ],
    "Management": [
        "RICP: head elevation 30°, avoid hypoxia/hypercapnia, osmotherapy (mannitol, hypertonic saline), avoid hypotension, treat underlying cause, EVD for hydrocephalus, decompressive craniectomy",
        "Aneurysm - securing the aneurysm:",
        "__Endovascular coiling (less invasive, preferred for posterior circulation)",
        "__Surgical clipping (open craniotomy)",
        "SAH management: nimodipine (60 mg 4-hourly x 21 days) - prevents vasospasm, maintain euvolaemia, treat hydrocephalus (EVD), analgesia, DVT prophylaxis",
        "Nursing: strict neuro obs, ICP monitoring, strict bed rest pre-operatively, quiet environment, maintain BP within target range, seizure precautions",
    ],
}))

# ── 6. MENINGITIS, ENCEPHALITIS, BRAIN ABSCESS, NEURO-CYSTICERCOSIS
topics.append(("6. Meningitis, Encephalitis, Brain Abscess, Neuro-Cysticercosis", {
    "Definition": [
        "Meningitis: inflammation of the meninges (pia, arachnoid, dura mater) surrounding the brain and spinal cord, usually due to infection.",
        "Encephalitis: inflammation of the brain parenchyma, usually viral.",
        "Brain Abscess: focal collection of pus within the brain parenchyma.",
        "Neuro-cysticercosis: CNS infection by the larval stage (cysticerci) of Taenia solium (pork tapeworm).",
    ],
    "Types": [
        "Meningitis: Bacterial (most severe), Viral (most common), Fungal (Cryptococcus - immunocompromised), TB",
        "Encephalitis: Viral (HSV-1 most common - temporal lobe), autoimmune (anti-NMDA receptor), arboviral (Japanese encephalitis, West Nile)",
        "Brain abscess: pyogenic (bacteria), fungal, parasitic",
        "Neuro-cysticercosis: parenchymal (most common), subarachnoid, intraventricular, spinal",
    ],
    "Etiology": [
        "Bacterial meningitis: Neisseria meningitidis (meningococcal - young adults), Streptococcus pneumoniae (pneumococcal - all ages), Listeria (elderly/immunocompromised), Group B Strep (neonates), H. influenzae",
        "TB meningitis: Mycobacterium tuberculosis",
        "Viral meningitis: Enteroviruses (most common), HSV-2, mumps, HIV",
        "Encephalitis: HSV-1, arboviruses, rabies, Nipah",
        "Brain abscess: Streptococci, Staphylococcus aureus (post-trauma), anaerobes; sources: otitis media, sinusitis, dental, endocarditis, haematogenous",
        "Neuro-cysticercosis: ingestion of T. solium eggs in contaminated food/water (faeco-oral); endemic in South Asia, Latin America, Africa",
    ],
    "Pathophysiology": [
        "Bacterial meningitis: bacteria enter CSF → LPS/teichoic acid triggers cytokine storm (TNF-α, IL-1, IL-6) → meningeal inflammation, BBB disruption, cerebral oedema, vasculitis, RICP",
        "Encephalitis (HSV): virus infects neurons of temporal lobe → necrosis, haemorrhage, Cowdry A intranuclear inclusions",
        "Brain abscess: 4 stages - early cerebritis → late cerebritis → early capsule → late capsule (well-formed abscess)",
        "Neuro-cysticercosis: cysts die → perilesional inflammation → oedema → seizures; calcified lesions remain as foci for seizures",
    ],
    "Clinical Manifestations": [
        "Meningitis triad: fever, headache, neck stiffness (nuchal rigidity)",
        "Photophobia, phonophobia, vomiting",
        "Kernig's sign: pain/resistance on knee extension with hip flexed",
        "Brudzinski's sign: involuntary knee flexion on neck flexion",
        "Petechial/purpuric rash: meningococcaemia (non-blanching)",
        "Altered consciousness (severe cases)",
        "Encephalitis: altered behaviour/consciousness, seizures, focal deficits, fever",
        "Brain abscess: headache, fever, focal deficits, seizures, RICP features",
        "Neuro-cysticercosis: seizures (most common), headache, raised ICP, hydrocephalus",
    ],
    "Diagnosis": [
        "CSF analysis (lumbar puncture) - key investigation:",
        "__Bacterial: turbid/purulent, WBC >1000 (neutrophils), protein high, glucose very low (<40% serum)",
        "__Viral: clear, WBC 100-500 (lymphocytes), protein mildly raised, glucose normal",
        "__TB: xanthochromic, lymphocytes, very high protein, very low glucose, pellicle formation",
        "CT/MRI head: before LP if signs of raised ICP; ring-enhancing lesion (abscess, toxoplasmosis)",
        "Blood cultures, CBC, CRP, procalcitonin",
        "PCR: HSV-1, enterovirus, meningococcal",
        "Neuro-cysticercosis: MRI (cysts in various stages), serology (EITB), multiple calcifications",
    ],
    "Management": [
        "Bacterial meningitis: IV ceftriaxone (2 g BD); dexamethasone 0.15 mg/kg 6-hourly x 4 days (started before/with first antibiotic dose); isolation",
        "TB meningitis: HRZE x 2 months then HR x 10 months; dexamethasone",
        "Viral meningitis: supportive care",
        "HSV encephalitis: IV acyclovir 10 mg/kg 8-hourly x 14-21 days (start empirically)",
        "Brain abscess: IV antibiotics (ceftriaxone + metronidazole); surgical drainage for abscess >2.5 cm or deteriorating patient",
        "Neuro-cysticercosis: albendazole + praziquantel (antiparasitic); dexamethasone; anti-epileptics",
        "Nursing: isolation precautions, neuro obs, seizure precautions, IV access, fluid balance, dark quiet room, antipyretics, bed rest, head elevation",
    ],
}))

# ── 7. MOVEMENT DISORDERS ───────────────────────────────────────
topics.append(("7. Movement Disorders: Chorea, Seizures & Epilepsies", {
    "Definition": [
        "Chorea: involuntary, irregular, non-rhythmic, flowing movements that move randomly from one body part to another.",
        "Seizure: a transient episode of abnormal, excessive, or synchronous neuronal activity in the brain, manifesting as sensory, motor, autonomic, or cognitive symptoms.",
        "Epilepsy: a chronic brain disorder characterised by a predisposition to recurrent unprovoked seizures (at least 2 unprovoked seizures >24 h apart, or 1 seizure with >60% recurrence risk over 10 years).",
    ],
    "Types": [
        "Chorea: Huntington's disease (genetic), Sydenham's chorea (post-streptococcal), drug-induced (levodopa, antipsychotics), metabolic, SLE",
        "Seizure types (ILAE 2017):",
        "__Focal onset: aware vs impaired awareness; motor vs non-motor",
        "__Generalised onset: tonic-clonic, absence, myoclonic, tonic, clonic, atonic",
        "__Unknown onset",
        "Epilepsy syndromes: childhood absence, juvenile myoclonic, temporal lobe epilepsy, Lennox-Gastaut",
        "Status epilepticus: seizure >5 minutes or >2 seizures without full recovery",
    ],
    "Etiology": [
        "Idiopathic/genetic (most common): ion channel mutations (SCN1A, KCNQ2)",
        "Structural: cortical dysplasia, hippocampal sclerosis, tumour, stroke, trauma",
        "Metabolic: hypoglycaemia, hyponatraemia, hypocalcaemia, hepatic/uraemic encephalopathy",
        "Infectious: meningitis, encephalitis, neurocysticercosis",
        "Autoimmune: anti-NMDAR, anti-LGI1, anti-CASPR2 encephalitis",
        "Chorea: Huntington's (autosomal dominant, CAG repeat expansion on chr 4), rheumatic fever (Sydenham's)",
    ],
    "Pathophysiology": [
        "Epilepsy: imbalance between excitation (glutamate) and inhibition (GABA) in neural networks → burst firing → synchronised epileptiform discharge",
        "Focal seizures: abnormal discharge in one cortical region → may spread (Jacksonian march) or secondarily generalise",
        "Generalised seizures: simultaneous bilateral cortical/subcortical involvement from onset",
        "Chorea (Huntington's): degeneration of striatal GABAergic neurons → disinhibition of thalamus → excessive thalamocortical activity",
        "Sydenham's chorea: molecular mimicry - anti-streptococcal antibodies cross-react with basal ganglia antigens",
    ],
    "Clinical Manifestations": [
        "Chorea: random writhing movements, grimacing, choreiform gait; in Huntington's: progressive cognitive decline, behavioural changes, dementia",
        "Focal aware seizure (simple partial): motor jerking, sensory aura, automatisms - consciousness preserved",
        "Focal impaired awareness (complex partial): staring, lip-smacking, automatisms, post-ictal confusion",
        "Generalised tonic-clonic (GTCS): tonic phase (stiffening, apnoea, cyanosis) → clonic phase (rhythmic jerking) → post-ictal drowsiness",
        "Absence: sudden brief staring, eye blinking, immediate return to normal; 3 Hz spike-wave on EEG",
        "Status epilepticus: prolonged seizure, risk of hypoxic brain damage, aspiration, rhabdomyolysis",
    ],
    "Diagnosis": [
        "EEG: epileptiform discharges, seizure type characterisation",
        "MRI brain (epilepsy protocol): structural causes - mesial temporal sclerosis, cortical dysplasia, tumour",
        "Blood: glucose, electrolytes, calcium, LFT, RFT, AED levels, genetic testing",
        "Video-EEG monitoring: for surgery evaluation",
        "CSF: if infectious/autoimmune encephalitis suspected",
        "Huntington's: genetic testing (CAG repeat number), CT/MRI (caudate atrophy)",
    ],
    "Management": [
        "First-line AEDs: sodium valproate (broad spectrum), lamotrigine, levetiracetam, carbamazepine (focal)",
        "Absence: ethosuximide or valproate",
        "Status epilepticus protocol:",
        "__0-5 min: position, O2, IV access, glucose",
        "__5-20 min: IV lorazepam 4 mg (or diazepam 10 mg IV/rectal)",
        "__20-40 min: IV phenytoin/fosphenytoin or levetiracetam or valproate",
        "__>40 min: anaesthesia (propofol, midazolam, thiopentone) + ICU",
        "Chorea: tetrabenazine (dopamine depletor), haloperidol; Sydenham's: penicillin prophylaxis",
        "Nursing seizure care: protect from injury, turn on side (recovery position), O2, time the seizure, do not restrain, call for help, post-ictal monitoring",
    ],
}))

# ── 8. CVA ───────────────────────────────────────────────────────
topics.append(("8. Cerebrovascular Disorders: CVA (Stroke)", {
    "Definition": ["Cerebrovascular accident (CVA/Stroke): a sudden neurological deficit caused by disruption of blood supply to the brain, either by occlusion (ischaemic) or rupture (haemorrhagic) of blood vessels, lasting >24 hours or resulting in death. TIA (transient ischaemic attack) is a similar episode lasting <24 hours with no infarct on imaging."],
    "Types": [
        "Ischaemic stroke (85%):",
        "__Thrombotic: in-situ atherosclerosis (large vessel disease)",
        "__Embolic: cardiac source (AF, valve disease), artery-to-artery",
        "__Lacunar: small vessel disease (hypertension/DM) - internal capsule, basal ganglia, thalamus",
        "Haemorrhagic stroke (15%):",
        "__Intracerebral haemorrhage (ICH): hypertensive bleeds (putamen most common), AVM, amyloid angiopathy",
        "__Subarachnoid haemorrhage (SAH): aneurysm rupture",
        "Anterior circulation strokes (ICA, MCA, ACA) vs Posterior circulation (vertebrobasilar)",
    ],
    "Etiology": [
        "Major risk factors: hypertension (most important), atrial fibrillation, diabetes mellitus, hyperlipidaemia, smoking, obesity, carotid artery disease",
        "Others: hypercoagulable states, OCP, cocaine, alcohol, infective endocarditis, vasculitis",
    ],
    "Pathophysiology": [
        "Ischaemic: occlusion → cessation of glucose/O2 → failure of Na-K ATPase → cytotoxic oedema → cell death",
        "Ischaemic penumbra: zone of potentially salvageable tissue around infarct core - rationale for thrombolysis",
        "Excitotoxicity: glutamate release → Ca2+ influx → mitochondrial dysfunction → apoptosis",
        "ICH: hypertensive vessel rupture → haematoma expansion → oedema → midline shift",
        "Timeline: infarct core dead within minutes; penumbra viable for 4.5-6 hours (golden hour)",
    ],
    "Clinical Manifestations": [
        "FAST acronym: Face drooping, Arm weakness, Speech difficulty, Time to call",
        "MCA stroke: contralateral hemiplegia (face and arm > leg), hemisensory loss, homonymous hemianopia, aphasia (dominant), neglect (non-dominant)",
        "ACA stroke: contralateral leg weakness > arm, personality changes, incontinence",
        "PCA stroke: homonymous hemianopia, cortical blindness, memory impairment",
        "Brainstem: crossed deficits (ipsilateral CN + contralateral body), dysphagia, dysarthria, ataxia, vertigo, diplopia",
        "ICH: sudden onset headache, vomiting, rapid neuro deterioration, hypertension",
        "Lacunar syndromes: pure motor, pure sensory, ataxic hemiparesis, dysarthria-clumsy hand",
    ],
    "Diagnosis": [
        "CT head (immediate): rules out haemorrhage before thrombolysis; early ischaemic changes",
        "MRI brain (DWI): most sensitive for acute ischaemia",
        "CT/MR angiography: large vessel occlusion for thrombectomy",
        "ECG, Holter monitoring: AF detection",
        "Echocardiography: cardiac source",
        "Blood: glucose (exclude hypoglycaemia), CBC, coagulation, lipids, HbA1c",
        "Carotid Doppler: carotid stenosis",
        "NIHSS: stroke severity scoring",
    ],
    "Management": [
        "Hyperacute (0-4.5 hours) ischaemic:",
        "__IV alteplase (0.9 mg/kg): if no haemorrhage, onset <4.5 h, no contraindications",
        "__IV tenecteplase (alternative, easier administration)",
        "__Mechanical thrombectomy: large vessel occlusion within 6-24 hours",
        "Antiplatelet: aspirin 300 mg within 24-48 h (not if haemorrhagic)",
        "Antihypertensives: cautious lowering (avoid in ischaemic stroke except extreme hypertension >220/120)",
        "Secondary prevention: anticoagulation (warfarin/DOAC) for AF, antiplatelet for non-cardioembolic, statins, BP control",
        "ICH: BP lowering (<140 mmHg), reverse anticoagulation, surgical evacuation (selected cases)",
        "Stroke unit care: 24-hour monitoring, early dysphagia screening, physiotherapy, speech therapy, occupational therapy",
        "Nursing: neuro obs (GCS, NIHSS), positioning (head 0-15° for ischaemic), aspiration precautions, catheter care, pressure area care, early mobilisation",
    ],
}))

# ── 9. CRANIAL/SPINAL NEUROPATHIES ──────────────────────────────
topics.append(("9. Cranial & Spinal Neuropathies: Bell's Palsy & Trigeminal Neuralgia", {
    "Definition": [
        "Bell's Palsy: acute, unilateral, idiopathic peripheral (LMN) facial nerve (CN VII) palsy causing sudden facial weakness/paralysis.",
        "Trigeminal Neuralgia (Tic Douloureux): sudden, severe, brief, recurrent, electric shock-like facial pain in the distribution of the trigeminal nerve (CN V), typically triggered by light touch.",
    ],
    "Types": [
        "Bell's Palsy: idiopathic (most cases); complete vs incomplete palsy",
        "Trigeminal Neuralgia: Classical TN (vascular compression), Secondary TN (MS, tumour), Idiopathic TN",
        "TN branches: V1 (ophthalmic), V2 (maxillary - most common), V3 (mandibular)",
        "Spinal neuropathies: radiculopathy (nerve root), mononeuropathy (single nerve), plexopathy",
    ],
    "Etiology": [
        "Bell's Palsy: HSV-1 reactivation (most likely), herpes zoster (Ramsay Hunt syndrome), immune-mediated inflammation, post-viral",
        "Trigeminal Neuralgia: vascular compression of CN V at the root entry zone (superior cerebellar artery in 75%), MS (demyelination of CN V root), tumour",
        "Spinal neuropathies: disc herniation, diabetic neuropathy, entrapment, trauma, vasculitis",
    ],
    "Pathophysiology": [
        "Bell's Palsy: viral reactivation/inflammation → oedema of CN VII in narrow bony facial canal → ischaemic compression → demyelination/axonal degeneration",
        "Trigeminal Neuralgia: focal demyelination at root entry zone → ephaptic transmission (cross-talk between pain and touch fibres) → light touch triggers pain burst",
        "Vascular pulsation on nerve → segmental demyelination → ectopic discharge",
    ],
    "Clinical Manifestations": [
        "Bell's Palsy: unilateral facial drooping (mouth), inability to close eye (lagophthalmos), loss of forehead wrinkles, Bell's phenomenon (eye rolls up on attempted closure), loss of taste (anterior 2/3 tongue), hyperacusis, post-auricular pain",
        "UMN vs LMN facial palsy: Bell's = LMN (forehead spared in UMN - receives bilateral cortical input)",
        "Trigeminal Neuralgia: paroxysmal electric shock/stabbing pain lasting seconds, triggered by touch, eating, talking, tooth brushing; trigger zones on face; pain-free intervals; no sensory loss",
    ],
    "Diagnosis": [
        "Bell's Palsy: clinical diagnosis; exclude other causes (parotid tumour, Lyme disease, trauma, Ramsay Hunt)",
        "MRI brain with gadolinium: if atypical or no recovery",
        "EMG/NCS: severity of nerve damage, prognostic",
        "Trigeminal Neuralgia: clinical diagnosis; MRI brain (CISS/FIESTA sequences): vascular loop compressing CN V, MS lesions",
        "Exclude dental or sinus causes",
    ],
    "Management": [
        "Bell's Palsy:",
        "__Corticosteroids: prednisolone 50 mg/day x 10 days (start within 72 hours)",
        "__Antivirals: acyclovir/valacyclovir (if started with steroids, uncertain benefit alone)",
        "__Eye care: artificial tears, lubricating ointment at night, eye patch/tape - prevent corneal exposure keratitis",
        "__Physiotherapy: facial exercises",
        "__Most patients (85%) recover fully in 3-6 months",
        "Trigeminal Neuralgia:",
        "__First-line: carbamazepine 100-200 mg BD (highly effective; monitor Na+ and CBC)",
        "__Alternative: oxcarbazepine, gabapentin, baclofen, lamotrigine",
        "__Surgical: microvascular decompression (MVD - Janetta procedure) - most effective long-term; Gamma Knife radiosurgery; percutaneous rhizotomy",
        "Nursing: explain diagnosis, reassure regarding recovery, eye care education, diet modification (soft foods for TN), emotional support",
    ],
}))

# ── 10. PERIPHERAL NEUROPATHIES ─────────────────────────────────
topics.append(("10. Peripheral Neuropathies", {
    "Definition": ["Peripheral neuropathy refers to damage or disease affecting the peripheral nervous system (nerves outside the brain and spinal cord - spinal nerve roots, dorsal root ganglia, peripheral nerves, neuromuscular junction, and muscles). It results in motor, sensory, and/or autonomic dysfunction."],
    "Types": [
        "By distribution: mononeuropathy (single nerve), mononeuritis multiplex, polyneuropathy (symmetric, length-dependent)",
        "By fibre type: large fibre (vibration, proprioception loss, areflexia), small fibre (pain, temperature, autonomic)",
        "By pathology: axonal (EMG: reduced amplitude), demyelinating (EMG: slowed conduction)",
        "Common types: diabetic (most common), alcoholic, nutritional, immune-mediated (AIDP/GBS, CIDP), hereditary (Charcot-Marie-Tooth), toxic, vasculitic",
    ],
    "Etiology": [
        "Metabolic/systemic: diabetes (most common), hypothyroidism, uraemia, hepatic disease",
        "Nutritional: B12 deficiency (subacute combined degeneration), B1 (thiamine - Beriberi), B6 deficiency",
        "Toxic: alcohol, isoniazid, metronidazole, chemotherapy (vincristine, cisplatin)",
        "Immune: GBS (post-infectious), CIDP, vasculitic neuropathy",
        "Infectious: HIV, leprosy, Lyme disease",
        "Hereditary: CMT disease (PMP22 gene mutations)",
        "Compression/entrapment: carpal tunnel (median nerve), cubital tunnel (ulnar), common peroneal palsy",
    ],
    "Pathophysiology": [
        "Axonal degeneration: metabolic/toxic insult → distal axon degeneration (dying-back neuropathy) → secondary myelin breakdown",
        "Demyelination: immune attack on myelin (GBS/CIDP) → slowed/blocked conduction → weakness, areflexia",
        "Diabetic neuropathy: chronic hyperglycaemia → polyol pathway activation, AGE formation, oxidative stress, endoneurial ischaemia → axon loss",
        "Length-dependent: longest fibres affected first → stocking-glove pattern",
    ],
    "Clinical Manifestations": [
        "Sensory: numbness, tingling (paraesthesia), burning pain, loss of vibration/proprioception",
        "Stocking-glove distribution (polyneuropathy): starts in feet, ascends proximally",
        "Motor: distal weakness, wasting, areflexia, foot drop",
        "Autonomic: postural hypotension, gastroparesis, erectile dysfunction, sweating abnormalities, cardiac arrhythmias",
        "Diabetic painful neuropathy: burning/shooting pain worse at night",
        "Charcot foot (neuropathic arthropathy): bone/joint destruction due to sensory loss",
    ],
    "Diagnosis": [
        "Clinical examination: sensory testing (pin-prick, vibration, proprioception), reflexes, motor strength",
        "EMG/NCS: confirms neuropathy, distinguishes axonal vs demyelinating",
        "Blood: glucose, HbA1c, B12, folate, TFT, renal/liver function, SPEP, anti-ganglioside antibodies (GBS), ANCA",
        "Nerve biopsy: vasculitic/infiltrative neuropathy",
        "Skin punch biopsy: small fibre neuropathy (intraepidermal nerve fibre density)",
        "Genetic testing: hereditary neuropathies",
    ],
    "Management": [
        "Treat underlying cause: tight glycaemic control (diabetic), abstain from alcohol, B12 replacement, IVIG/plasmapheresis (GBS/CIDP)",
        "Neuropathic pain: duloxetine, gabapentin/pregabalin, amitriptyline, tramadol; topical capsaicin/lidocaine",
        "Foot care (diabetic): regular inspection, properly fitting footwear, podiatry, treat wounds promptly",
        "Physiotherapy: strengthening, balance training, AFO for foot drop",
        "Nursing: foot inspection education, fall prevention, pain management, patient education on avoiding heat/injury to numb areas",
    ],
}))

# ── 11. ALZHEIMER'S & PARKINSON'S ───────────────────────────────
topics.append(("11. Degenerative Diseases: Alzheimer's Disease & Parkinson's Disease", {
    "Definition": [
        "Alzheimer's Disease (AD): the most common cause of dementia, a progressive neurodegenerative disorder characterised by cognitive decline, memory loss, and behavioural changes due to amyloid plaques and neurofibrillary tangles.",
        "Parkinson's Disease (PD): a progressive neurodegenerative movement disorder characterised by dopamine deficiency in the substantia nigra, causing the classic motor triad of tremor, rigidity, and bradykinesia.",
    ],
    "Types": [
        "Alzheimer's: Sporadic (late-onset, >65 years, most common), Familial/Early-onset (<65 years, <5% - APP, PSEN1, PSEN2 mutations)",
        "Dementia with Lewy Bodies (DLB), Vascular dementia, Frontotemporal dementia (FTD) - other dementias",
        "Parkinson's: Idiopathic PD (most common), Secondary Parkinsonism (drug-induced, vascular, post-encephalitic), Parkinson-plus syndromes (MSA, PSP, CBD)",
    ],
    "Etiology": [
        "Alzheimer's: advancing age (greatest risk), APOE ε4 allele (genetic risk), Down syndrome, family history, cardiovascular risk factors, low education/cognitive reserve",
        "Parkinson's: idiopathic (most), age, LRRK2/SNCA/PARKIN gene mutations (familial), pesticide/toxin exposure (MPTP, rotenone), repeated head trauma",
    ],
    "Pathophysiology": [
        "Alzheimer's: amyloid cascade hypothesis: abnormal cleavage of APP → Aβ42 accumulates → senile plaques → tau hyperphosphorylation → neurofibrillary tangles → synaptic loss → neurodegeneration; cholinergic deficit (nucleus basalis of Meynert)",
        "Parkinson's: selective loss of dopaminergic neurons in substantia nigra pars compacta → reduced dopamine in striatum → imbalance of direct/indirect basal ganglia pathways → bradykinesia, rigidity; Lewy bodies (α-synuclein aggregates) - pathological hallmark",
        "PD direct pathway: facilitates movement; indirect pathway: suppresses movement; dopamine loss → indirect pathway dominates → movement suppressed",
    ],
    "Clinical Manifestations": [
        "Alzheimer's: early - short-term memory loss, word-finding difficulty; middle - confusion, disorientation, behavioural changes, apraxia, agnosia; late - loss of self-care, incontinence, bedridden, death",
        "Mini-Mental State Examination (MMSE): ≤23/30 (mild cognitive impairment/dementia)",
        "Parkinson's TRAP: Tremor (resting, pill-rolling, 4-6 Hz), Rigidity (cogwheel/leadpipe), Akinesia/Bradykinesia, Postural instability",
        "Parkinson's other: hypomimia (masked facies), micrographia, shuffling gait, festination, freezing, dysphonia, dysphagia",
        "Non-motor PD: depression (40%), dementia (PDD), autonomic dysfunction (constipation, orthostatic hypotension, bladder), REM sleep behaviour disorder, hyposmia (early sign)",
        "Dementia with Lewy bodies: visual hallucinations, fluctuating cognition, Parkinsonism, REM sleep disorder",
    ],
    "Diagnosis": [
        "Alzheimer's: clinical diagnosis; MMSE, MoCA (Montreal Cognitive Assessment); CT/MRI: cortical atrophy, hippocampal atrophy; PET scan (amyloid PET, FDG-PET); CSF: low Aβ42, elevated tau/p-tau; exclude reversible causes (B12, TFT, syphilis, HIV)",
        "Parkinson's: clinical diagnosis (UK PDS Brain Bank criteria: bradykinesia + ≥1 of: rigidity, rest tremor, postural instability); MRI brain: to exclude secondary causes; DaTscan (dopamine transporter SPECT): confirms dopaminergic deficit; positive response to levodopa supports diagnosis",
    ],
    "Management": [
        "Alzheimer's:",
        "__Cholinesterase inhibitors: donepezil, rivastigmine, galantamine (mild-moderate AD)",
        "__NMDA antagonist: memantine (moderate-severe AD or combination)",
        "__Anti-amyloid: lecanemab, donanemab (FDA approved 2023-2024 for early AD)",
        "__Non-pharmacological: cognitive stimulation, structured activities, caregiver support, safe environment",
        "__Manage BPSD: antipsychotics cautiously (risperidone), antidepressants for depression",
        "Parkinson's:",
        "__Levodopa + carbidopa (gold standard): most effective; motor fluctuations develop over time (wearing-off, on-off, dyskinesias)",
        "__Dopamine agonists: pramipexole, ropinirole (younger patients, delay levodopa)",
        "__MAO-B inhibitors: rasagiline, selegiline (mild disease, neuroprotection debated)",
        "__COMT inhibitors: entacapone (adjunct to reduce wearing-off)",
        "__Amantadine: for dyskinesias",
        "__Deep Brain Stimulation (DBS): subthalamic nucleus/GPi - advanced PD with motor fluctuations",
        "Nursing for both: safety (fall prevention, bed rails, non-slip footwear), nutrition (dysphagia diet), bowel/bladder care, skin integrity, reality orientation (AD), medication compliance (PD), caregiver education and support, maintain dignity",
    ],
}))

# ── 12. GUILLAIN-BARRE, MYASTHENIA GRAVIS, MULTIPLE SCLEROSIS ───
topics.append(("12. Guillain-Barré Syndrome, Myasthenia Gravis & Multiple Sclerosis", {
    "Definition": [
        "Guillain-Barré Syndrome (GBS): an acute, immune-mediated inflammatory polyradiculoneuropathy causing rapidly progressive ascending flaccid paralysis, often following infection.",
        "Myasthenia Gravis (MG): an autoimmune disorder of the neuromuscular junction caused by antibodies against acetylcholine receptors (AChR), resulting in fluctuating, fatigable muscle weakness.",
        "Multiple Sclerosis (MS): a chronic demyelinating and neurodegenerative disease of the CNS characterised by discrete plaques of demyelination in the white matter, causing variable neurological deficits.",
    ],
    "Types": [
        "GBS subtypes: AIDP (Acute Inflammatory Demyelinating Polyneuropathy - most common in West), AMAN (Acute Motor Axonal Neuropathy - C. jejuni associated), AMSAN, Miller Fisher Syndrome (ophthalmoplegia, ataxia, areflexia - anti-GQ1b antibodies)",
        "MG: ocular (15%, limited to ptosis/diplopia), generalised; AChR-Ab positive (85%), MuSK-Ab positive, seronegative",
        "MS: Relapsing-Remitting (RRMS - 85% initially), Primary Progressive (PPMS), Secondary Progressive (SPMS), Clinically Isolated Syndrome (CIS)",
    ],
    "Etiology": [
        "GBS: triggered by preceding infection (2-4 weeks prior): Campylobacter jejuni (most common), CMV, EBV, Zika, COVID-19, rarely post-vaccination",
        "MG: thymic abnormality (70% thymic hyperplasia, 10-15% thymoma), autoimmune AChR antibodies",
        "MS: multifactorial - genetic susceptibility (HLA-DRB1*15:01), low vitamin D, EBV infection, smoking, latitude effect (more prevalent away from equator)",
    ],
    "Pathophysiology": [
        "GBS: molecular mimicry - antibodies against pathogen cross-react with gangliosides on peripheral nerve myelin → complement-mediated myelin destruction (AIDP) or axonal injury (AMAN) → conduction block → ascending weakness",
        "MG: anti-AChR antibodies → complement activation → degradation of AChR → reduced ACh binding → impaired NMJ transmission → fatigable weakness worsens with repetitive activity",
        "MS: autoreactive T-cells breach BBB → attack myelin/oligodendrocytes → demyelination plaques → conduction slowing/block → relapse; axonal transection (progressive phase) → permanent disability; Uhthoff phenomenon: symptoms worsen with heat",
    ],
    "Clinical Manifestations": [
        "GBS: rapidly ascending flaccid weakness starting in legs (days to weeks), areflexia, mild sensory symptoms, autonomic dysfunction (HR variability, hypo/hypertension, urinary retention), respiratory failure (30% need ventilation), back pain",
        "Nadir at 4 weeks; recovery over months; Brighton criteria for diagnosis",
        "MG: ptosis (drooping eyelids - worse toward end of day), diplopia, dysarthria, dysphagia, proximal limb weakness; fatigue on repetitive use; myasthenic crisis - respiratory failure triggered by infection/medication",
        "MS: optic neuritis (painful unilateral visual loss, RAPD), internuclear ophthalmoplegia (INO), Lhermitte's sign, cerebellar ataxia, intention tremor, bladder dysfunction, spasticity, cognitive impairment, fatigue, heat sensitivity (Uhthoff's)",
        "McDonald criteria (2017): dissemination in space (DIS) and time (DIT) of CNS lesions",
    ],
    "Diagnosis": [
        "GBS: EMG/NCS (demyelinating or axonal pattern), CSF (albuminocytological dissociation - high protein, normal cells), anti-ganglioside antibodies (anti-GM1 in AMAN, anti-GQ1b in MFS), nerve imaging",
        "MG: Tensilon (edrophonium) test - brief improvement after IV anticholinesterase; anti-AChR antibody titre; anti-MuSK antibodies; repetitive nerve stimulation (RNS) - decrement >10%; single-fibre EMG (most sensitive); CT chest (thymoma)",
        "MS: MRI brain+spine (T2/FLAIR hyperintense plaques - periventricular, juxtacortical, infratentorial); gadolinium enhancement (active lesions); CSF (oligoclonal bands in >90%, IgG index elevated); VEPs (prolonged latency in optic neuritis)",
    ],
    "Management": [
        "GBS:",
        "__IVIG 0.4 g/kg/day x 5 days OR plasmapheresis (5 sessions over 2 weeks) - equally effective",
        "__Corticosteroids: NOT indicated",
        "__Respiratory monitoring: serial FVC; intubate if FVC <15-20 mL/kg or <20-30% predicted",
        "__DVT prophylaxis, pain management (gabapentin, opioids), bowel/bladder care, physiotherapy",
        "MG:",
        "__Symptomatic: pyridostigmine (acetylcholinesterase inhibitor)",
        "__Immunosuppression: prednisolone, azathioprine, mycophenolate, ciclosporin",
        "__Myasthenic crisis: ICU, ventilatory support, IVIG or plasmapheresis",
        "__Thymectomy: improves outcomes (even without thymoma) in AChR-positive generalised MG",
        "__Eculizumab, ravulizumab (complement inhibitors), efgartigimod (FcRn inhibitor): newer biologics",
        "MS:",
        "__Acute relapse: IV methylprednisolone 1 g/day x 3-5 days (shortens duration, not long-term outcome)",
        "__Disease-modifying therapies (DMTs):",
        "___Mild-moderate: IFN-beta, glatiramer acetate, teriflunomide, dimethyl fumarate",
        "___High efficacy: natalizumab, alemtuzumab, ocrelizumab (B-cell depleter - also for PPMS), cladribine",
        "__Symptomatic: baclofen/tizanidine (spasticity), oxybutynin (bladder), modafinil (fatigue), fampridine (walking)",
        "Nursing for all three: respiratory monitoring (GBS - measure VC regularly), fall prevention, ADL assistance, psychosocial support, patient education, medication compliance, physiotherapy coordination, pressure care",
    ],
}))

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# ── Cover Page ───────────────────────────────────────────────────
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info_lines = [
    "Covers: Definition | Types | Etiology | Pathophysiology",
    "Clinical Manifestations | Diagnosis | Management",
    "",
    "Topics included:",
    "Headache • Head Injuries • Spinal Injuries • Disc Herniation",
    "Intracranial/Cerebral Aneurysms • Meningitis & Encephalitis",
    "Seizures & Epilepsies • CVA/Stroke • Bell's Palsy & TN",
    "Peripheral Neuropathies • Alzheimer's & Parkinson's Disease",
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# ── Table of Contents ────────────────────────────────────────────
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toc_items = [
    "1.  Headache",
    "2.  Head Injuries",
    "3.  Spinal Injuries: Paraplegia, Hemiplegia, Quadriplegia",
    "4.  Spinal Cord Compression: Herniation of Intervertebral Disc",
    "5.  Intracranial Pressure & Cerebral Aneurysms",
    "6.  Meningitis, Encephalitis, Brain Abscess, Neuro-Cysticercosis",
    "7.  Movement Disorders: Chorea, Seizures & Epilepsies",
    "8.  Cerebrovascular Disorders: CVA (Stroke)",
    "9.  Cranial & Spinal Neuropathies: Bell's Palsy & Trigeminal Neuralgia",
    "10. Peripheral Neuropathies",
    "11. Degenerative Diseases: Alzheimer's & Parkinson's Disease",
    "12. Guillain-Barré Syndrome, Myasthenia Gravis & Multiple Sclerosis",
]
for item in toc_items:
    story.append(Paragraph(item, toc_style))
    story.append(Spacer(1, 4))

# ── Topic Sections ───────────────────────────────────────────────
colors_cycle = [NAVY, TEAL, colors.HexColor("#2E5090"), TEAL, NAVY, colors.HexColor("#1A6B5A")]

for i, (title, sections) in enumerate(topics):
    col = colors_cycle[i % len(colors_cycle)]
    story.extend(topic_block(title, sections, color=col))

# ── Build ────────────────────────────────────────────────────────
doc.build(story)
print(f"PDF successfully created: {OUTPUT}")

cd /home/daytona/workspace/neuro-nursing-pdf && python generate_pdf.py 2>&1

ls -lh /home/daytona/workspace/neuro-nursing-pdf/Nursing_Management_Neurological…