Neurology
Core concepts
Master stroke localization and the time-critical pathway: recognize stroke, obtain non-contrast CT to exclude hemorrhage, and give thrombolysis within the window if eligible; thrombectomy for large-vessel occlusion. Know the difference between ischemic and hemorrhagic stroke, transient ischemic attack, and the secondary prevention strategies. Cover seizure classification and status epilepticus management (benzodiazepine first, then a second-line antiepileptic), headache red flags (thunderclap, fever, focal deficit, papilledema), and the approach to weakness (upper vs lower motor neuron signs). Understand meningitis/encephalitis, Guillain-Barré syndrome, and myasthenia gravis.
Traps
Examiners test the "time is brain" rule and the fact that CT is normal in early ischemia - do not be reassured. Watch for the difference between Bell's palsy (lower motor neuron, entire face) and a central lesion (forehead spared). Remember that status epilepticus requires a benzodiazepine first, and that a lumbar puncture is contraindicated with signs of raised intracranial pressure.
Worked rule of thumb
Sudden focal deficit: check glucose immediately (hypoglycemia mimics stroke), then activate the stroke pathway and obtain CT. Thrombolysis requires exclusion of hemorrhage, controlled blood pressure, and no contraindications.
Key points
- Check glucose in any acute neurologic deficit.
- Non-contrast CT excludes hemorrhage before thrombolysis.
- Status epilepticus: benzodiazepine first.
- Thunderclap headache suggests subarachnoid hemorrhage.
- Forehead sparing indicates an upper motor neuron facial palsy.