Neurology
Core framework
Localise the lesion first: cortex, brainstem, spinal cord, nerve, neuromuscular junction, or muscle - then define the time course (hyperacute, acute, chronic). In stroke, remember time is brain: recognise thrombolysis and thrombectomy windows, and distinguish ischaemic from haemorrhagic stroke before treatment. In weakness, define whether it is upper or lower motor neuron, and whether it is symmetric and proximal (myopathy) or distal and sensory (neuropathy).
Concepts examiners test
Stroke: recognition scales, imaging, thrombolysis contraindications, blood pressure targets, and secondary prevention. Seizures: classification, status epilepticus management, and first-line antiepileptic choice. Headache: red flags and subarachnoid haemorrhage diagnosis. Multiple sclerosis: presentation, MRI, and relapse management. Myasthenia gravis: fatigable weakness, respiratory monitoring, and crisis management. Guillain–Barré syndrome: ascending weakness, areflexia, cerebrospinal fluid findings, and respiratory monitoring. Parkinson disease and its drug complications; and delirium versus dementia.
Traps
- Do not give thrombolysis without excluding haemorrhage on imaging and reviewing contraindications.
- Normal CT does not exclude subarachnoid haemorrhage early; proceed to lumbar puncture if suspicion remains.
- Myasthenic crisis and Guillain–Barré syndrome can cause respiratory failure - monitor vital capacity, not just oxygen saturation.
- Status epilepticus needs benzodiazepines first, then a second-line agent.
- Steroids are harmful in Guillain–Barré syndrome as monotherapy.
Worked rule of thumb
A patient with acute unilateral weakness and a last-known-well time within the thrombolysis window: activate stroke pathway, obtain urgent imaging, check glucose, and assess contraindications. If imaging shows haemorrhage, reverse anticoagulation and manage blood pressure - never thrombolyse.