Saraf dan Psikiatri
Core concepts
Localise neurological lesions: which side, which level, upper versus lower motor neuron signs, and which vascular territory. Know stroke thrombolysis and thrombectomy windows, and the distinction between ischaemic and haemorrhagic stroke on imaging. Understand headache red flags (thunderclap, fever, focal deficit, papilloedema), meningitis and encephalitis, and seizure classification with status epilepticus management. Review neuromuscular disease, peripheral neuropathy patterns, and movement disorders. Psychiatry: recognise depression, psychosis, bipolar disorder, anxiety, and delirium; know the risks of antipsychotics and the principles of capacity assessment and suicide risk evaluation.
Traps
Delirium is acute and fluctuating with altered attention - do not label it dementia. In status epilepticus, benzodiazepines come first, then a second-line antiepileptic. Do not perform lumbar puncture before imaging in a patient with focal signs, papilloedema, or reduced consciousness. Thunderclap headache means subarachnoid haemorrhage until excluded. Serotonin syndrome and neuroleptic malignant syndrome are distinguished by onset, clonus, and rigidity.
Worked example
A 70-year-old has sudden right-sided weakness and expressive aphasia with onset 90 minutes ago. Diagnosis: left middle cerebral artery ischaemic stroke. Rule of thumb: urgent non-contrast CT excludes haemorrhage, then thrombolysis within the window if no contraindications; aphasia localises to the dominant hemisphere.