Neurology
Core concepts
Ischemic and hemorrhagic stroke, seizure and status epilepticus, headache syndromes including subarachnoid hemorrhage and migraine, multiple sclerosis, myasthenia gravis, Guillain-Barré syndrome, and peripheral neuropathy. Acute stroke care begins with glucose and noncontrast CT to exclude hemorrhage; thrombolysis is time-dependent and contraindicated with active bleeding, recent surgery, or uncontrolled hypertension. Status epilepticus is treated in sequence with benzodiazepines, then a second-line antiepileptic, then anesthesia. Subarachnoid hemorrhage may have a normal CT early; proceed to lumbar puncture after 12 hours if suspicion remains high.
Traps
- Missing hypoglycemia as a stroke mimic.
- Giving thrombolysis before excluding hemorrhage on imaging.
- Attributing thunderclap headache to migraine.
- Treating myasthenic crisis with steroids alone or with medications that worsen neuromuscular junction transmission.
- Forgetting respiratory monitoring in Guillain-Barré syndrome; vital capacity matters.
- Overlooking delirium in a neurologic patient.
Worked example
A 70-year-old has sudden right hemiparesis and aphasia with onset 90 minutes ago; glucose is 110 and CT shows no hemorrhage. Blood pressure is 180/100. The patient is within the thrombolysis window, and permissive hypertension is acceptable before treatment. Activate stroke protocol, obtain vascular imaging, and consider thrombectomy if a large vessel occlusion is present. Rule of thumb: time is brain; every minute of ischemia costs neurons.