UKOM Sp.N (Neurology) cheat sheet

Corticospinal tract decussates at the medullary pyramid; lesion above = contralateral weakness, below = ipsilateral.

Lateral corticospinal tract synapses on anterior horn; Babinski sign reflects loss of corticospinal inhibition.

Internal capsule: anterior limb (thalamocortical), genu (corticobulbar), posterior limb (corticospinal, sensory). Lacunar infarcts here cause pure motor or sensorimotor syndromes.

Broca area = pars opercularis/triangularis of inferior frontal gyrus (Brodmann 44/45); Wernicke area = posterior superior temporal gyrus (area 22).

Homunculus: leg medial (parasagittal, ACA), face lateral (MCA), hand intermediate; foot area supplied by ACA.

Cranial nerve nuclei: III/IV in midbrain, V–VIII in pons, IX–XII in medulla; CN VI exits at pontomedullary junction.

Cerebellar signs are ipsilateral: vermis = truncal ataxia; hemisphere = limb dysmetria; flocculonodular = nystagmus/gait.

Circle of Willis: A1, M1, P1 segments; anterior communicating connects ACAs, posterior communicating connects ICA to PCA.

Resting membrane potential ≈ −70 mV, set mainly by K+ conductance; Nernst equation E = 61.5·log([K]o/[K]i).

Action potential threshold ≈ −55 mV; depolarization by Na+ influx, repolarization by K+ efflux; refractory period from Na+ channel inactivation.

Myelinated conduction velocity ≈ 6 × axon diameter (m/s); demyelination slows conduction and disperses the compound action potential.

Synaptic transmission: Ca2+ influx → vesicle fusion (SNARE) → neurotransmitter release; GABA-A is Cl− channel (inhibitory), NMDA is Ca2+/Na+ (excitatory).

Cerebral blood flow ≈ 50 mL/100 g/min; autoregulation 60–160 mmHg MAP; CBF <20 causes EEG slowing, <10 causes infarction.

CSF: produced by choroid plexus ~500 mL/day, total volume ~150 mL, turnover 3–4×/day; normal opening pressure 10–20 cm H2O.

EEG rhythms: alpha 8–13 Hz occipital (eyes closed), beta >13 Hz frontal, theta 4–7 Hz, delta <4 Hz.

Dopamine pathways: nigrostriatal (motor), mesolimbic/mesocortical (reward, psychosis), tuberoinfundibular (prolactin inhibition).

Localization sequence: cortical → subcortical → brainstem → spinal cord → root/plexus → peripheral nerve → neuromuscular junction → muscle.

UMN lesion: spasticity, hyperreflexia, Babinski present, no fasciculations; LMN: flaccidity, atrophy, fasciculations, areflexia.

Sensory level on trunk localizes cord lesion ~1–2 segments above the level; Brown-Séquard = ipsilateral proprioceptive/motor loss + contralateral pain/temperature loss.

Cranial nerve pattern: crossed signs (ipsilateral face, contralateral body) localize to brainstem; bilateral signs suggest neuromuscular or systemic cause.

Unexplained coma: check pupils (pinpoint = pontine/opioid; fixed dilated = herniation/anticholinergic) and oculocephalic reflex.

Sudden-onset focal deficit = vascular until proven otherwise; thunderclap headache = SAH; progressive deficit over days = tumor, abscess, or inflammatory.

Aphasia vs dysarthria: aphasia impairs comprehension/naming and writing; dysarthria affects articulation with preserved language.

Red flags in headache: age >50, new onset, thunderclap, fever, papilledema, focal deficit, cancer, immunosuppression, positional change.

Ischemic stroke thrombolysis: alteplase/tenecteplase within 4.5 h of last known well; door-to-needle target <60 min.

Thrombectomy: large-vessel occlusion (ICA, M1, basilar) within 6 h, or 6–24 h with salvageable penumbra on perfusion/CT.

ASPECTS score: 10-point CT scoring; ≤6 predicts poor outcome and limits thrombectomy benefit.

ICH: BP lowering to systolic 130–140 mmHg within 6 h (INTERACT2/ATACH-II); reverse anticoagulation immediately; no routine steroids.

Aneurysmal SAH: CT within 6 h highly sensitive; if negative and suspicion high, LP for xanthochromia; nimodipine 60 mg q4h for 21 days.

Malignant MCA infarction: decompressive hemicraniectomy within 48 h in patients <60 years reduces mortality and improves outcome.

Neurocritical care: target PaO2 70–100 mmHg, normocapnia (PaCO2 35–40), normonatremia, normoglycemia, head of bed 30°.

Cerebral autoregulation is impaired in acute injury; avoid hypotension; CPP = MAP − ICP, target 60–70 mmHg in TBI.

Seizure classification: focal (aware/impaired awareness, focal to bilateral tonic-clonic) vs generalized (absence, myoclonic, tonic-clonic, atonic).

First-line: focal = levetiracetam, lamotrigine, carbamazepine; generalized tonic-clonic = valproate, levetiracetam, lamotrigine; absence = ethosuximide/valproate.

Valproate contraindicated in pregnancy (neural tube defects, neurodevelopmental harm); avoid in women of childbearing age.

Status epilepticus: benzodiazepine first-line, then levetiracetam, valproate, or phenytoin; refractory = anesthetic infusion (midazolam, propofol, thiopental).

EEG in absence: 3 Hz spike-and-wave, hyperventilation provokes; in Lennox-Gastaut: slow spike-and-wave (1.5–2.5 Hz).

Sleep: OSA diagnosed by AHI ≥5 with symptoms or ≥15 regardless; first-line CPAP; avoid sedatives.

Narcolepsy: MSLT mean sleep latency <8 min with ≥2 SOREMPs; cataplexy, hypnagogic hallucinations, sleep paralysis.

Driving: UK DVLA requires 12 months seizure-free for group 1 license after a first unprovoked seizure; 6 months after a provoked seizure.

Myasthenia gravis: fatigable weakness, ptosis/diplopia, anti-AChR or anti-MuSK; treat with pyridostigmine, steroids, azathioprine, thymectomy.

Lambert-Eaton: proximal weakness, hyporeflexia, autonomic features; anti-VGCC; associated with small cell lung cancer.

Guillain-Barré: ascending symmetric weakness, areflexia, albuminocytologic dissociation; IVIG or plasma exchange; monitor vital capacity.

Duchenne muscular dystrophy: X-linked dystrophin mutation, Gowers sign, calf pseudohypertrophy, elevated CK; steroids slow progression.

ALS: UMN + LMN signs, fasciculations, no sensory loss; riluzole and edaravone modest benefit; noninvasive ventilation for respiratory failure.

Myotonic dystrophy type 1: CTG repeat expansion, myotonia, cataracts, cardiac conduction defects, diabetes; monitor ECG.

Periodic paralysis: hypokalemic (channelopathy) responds to potassium; hyperkalemic to acetazolamide; avoid triggers.

Botulism: descending weakness, autonomic dysfunction, presynaptic block; antitoxin and supportive care.

Length-dependent neuropathy: stocking-glove sensory loss, reduced ankle reflexes; causes diabetes, alcohol, B12 deficiency, hypothyroidism, CKD.

NCS/EMG: demyelinating = slowed conduction velocity, prolonged distal latency, conduction block; axonal = reduced amplitude.

CIDP: progressive/relapsing, proximal and distal weakness, areflexia, CSF protein elevated; treat with IVIG, steroids, plasma exchange.

Rehabilitation after stroke: task-specific repetitive training, constraint-induced movement therapy for upper limb, early mobilization.

Spasticity: botulinum toxin for focal, baclofen (oral or intrathecal) for generalized; physiotherapy adjunct.

Neuropathic pain: gabapentin, pregabalin, duloxetine, amitriptyline first-line; opioids not recommended.

Pressure injury prevention: reposition every 2 h, skin inspection, nutritional support; spinal cord injury patients at high risk.

Brachial plexus: upper (Erb) C5–C6 = arm adducted, internally rotated; lower (Klumpke) C8–T1 = claw hand, Horner syndrome.

Multiple sclerosis: dissemination in space and time (McDonald criteria); CSF oligoclonal bands; MRI periventricular, juxtacortical, infratentorial, spinal cord lesions.

MS relapse: high-dose IV methylprednisolone 1 g daily for 3–5 days; disease-modifying therapy for relapsing-remitting disease.

Neuromyelitis optica spectrum disorder: anti-AQP4, longitudinally extensive transverse myelitis, optic neuritis; treat with rituximab, eculizumab, inebilizumab.

MOG antibody disease: optic neuritis, ADEM-like, transverse myelitis; often steroid-responsive; avoid certain MS DMTs.

Autoimmune encephalitis: anti-NMDAR (psychiatric onset, dyskinesias, ovarian teratoma), anti-LGI1 (faciobrachial dystonic seizures, hyponatremia).

Acute disseminated encephalomyelitis (ADEM): post-infectious, multifocal white matter lesions, children more common; steroids.

Anti-NMDAR encephalitis: CSF pleocytosis, EEG extreme delta brush; treat with steroids, IVIG/plasma exchange, tumor removal.

MS mimics: sarcoidosis, lupus, Sjögren, Behçet, CADASIL, vitamin B12 deficiency, HTLV-1.

Bacterial meningitis: CSF neutrophilic pleocytosis, low glucose, high protein; empiric ceftriaxone + vancomycin ± ampicillin (Listeria if >50 or immunocompromised).

Viral meningitis: lymphocytic pleocytosis, normal glucose; enterovirus most common; supportive care.

HSV encephalitis: temporal lobe involvement, hemorrhagic necrosis; IV aciclovir 10 mg/kg q8h for 14–21 days; start empirically.

TB meningitis: basal meningeal enhancement, hydrocephalus, low glucose; treat with 4-drug regimen plus steroids in HIV-negative.

HIV-associated neurocognitive disorder: screen with cognitive testing; ART is mainstay; CNS opportunistic infections depend on CD4 count.

Neurosyphilis: CSF VDRL, pleocytosis, elevated protein; treat with IV penicillin G 18–24 million units/day for 10–14 days.

Brain abscess: ring-enhancing lesion, source from dental/sinus/ear or hematogenous; aspirate for culture, antibiotics 6–8 weeks.

Prion disease (CJD): rapidly progressive dementia, myoclonus, periodic sharp wave complexes on EEG, elevated 14-3-3; no treatment.

Parkinson disease: bradykinesia + rigidity or rest tremor; levodopa/carbidopa is most effective; motor complications after 5–10 years.

Atypical parkinsonism: MSA (autonomic failure), PSP (vertical gaze palsy, falls), CBD (asymmetric cortical signs), DLB (fluctuating cognition, hallucinations).

Essential tremor: bilateral postural/kinetic tremor, improves with propranolol or primidone; alcohol-responsive.

Huntington disease: CAG repeat expansion, chorea, psychiatric features, dementia; autosomal dominant.

Alzheimer disease: episodic memory loss, medial temporal atrophy; cholinesterase inhibitors for mild-moderate, memantine for moderate-severe.

Frontotemporal dementia: behavioral variant (disinhibition, apathy) or language variant (PPA); MAPT, GRN, C9orf72 mutations.

Dystonia: focal (cervical, blepharospasm) treated with botulinum toxin; generalized may respond to deep brain stimulation.

Restless legs syndrome: urge to move, worse at rest/evening, relieved by movement; iron deficiency and dopamine agonists.

Migraine: unilateral, pulsating, 4–72 h, nausea, photophobia; acute triptans + NSAIDs; prophylaxis propranolol, topiramate, amitriptyline, CGRP monoclonal antibodies.

Tension-type headache: bilateral, pressing, mild-moderate, no nausea; NSAIDs/paracetamol; amitriptyline for prophylaxis.

Cluster headache: severe unilateral orbital pain with autonomic features, 15–180 min; high-flow oxygen + subcutaneous sumatriptan; verapamil prophylaxis.

Trigeminal neuralgia: lancinating facial pain in V2/V3; carbamazepine first-line; microvascular decompression if refractory.

Medication-overuse headache: headache ≥15 days/month with analgesic overuse; withdrawal and prophylaxis.

Giant cell arteritis: age >50, temporal tenderness, elevated ESR/CRP, jaw claudication; high-dose steroids immediately, biopsy.

Idiopathic intracranial hypertension: papilledema, headache, visual obscurations; acetazolamide, weight loss, shunt if vision threatened.

Postherpetic neuralgia: gabapentin, pregabalin, lidocaine patch, amitriptyline; prevention with zoster vaccine.

CT head: first-line for acute hemorrhage, trauma, raised ICP; hyperdense acute blood, hypodense ischemia after 6–12 h.

MRI DWI: most sensitive for acute infarction within minutes; restricted diffusion also in abscess, CJD, hypercellular tumors.

MRI T2/FLAIR: edema, demyelination, gliosis; T1 post-contrast: blood-brain barrier breakdown, tumors, infection.

Vascular imaging: CTA/MRA for large-vessel occlusion and aneurysm; DSA is gold standard for vasculitis and arteriovenous malformations.

Perfusion imaging (CTP/MRP): identifies penumbra for late-window thrombectomy; mismatch between core and hypoperfused tissue.

Spinal imaging: MRI with contrast for cord compression, abscess, tumor; CT for bony trauma.

PET: FDG for tumor grading and dementia; amyloid PET for Alzheimer pathology; DAT scan for parkinsonism.

Caution: gadolinium in renal impairment (NSF risk with older agents), and in pregnancy use only if essential.

EEG: 10–20 system electrode placement; referential or bipolar montage; standard 30-min recording, sleep deprivation and photic stimulation activate epileptiform discharges.

Epileptiform discharges: spikes, sharp waves, spike-and-wave; 3 Hz generalized = absence; temporal spikes = focal epilepsy.

EMG: insertional activity, spontaneous activity (fibrillations, positive sharp waves = denervation), motor unit potentials (large = chronic reinnervation).

NCS: sensory and motor amplitudes, conduction velocity, distal latency, F waves; compare with normal reference values and contralateral side.

Evoked potentials: VEP (demyelination, optic neuritis), BAEP (brainstem lesions), SEP (cord, plexus).

Nerve biopsy: reserved for suspected vasculitis, amyloid, leprosy, or unexplained progressive neuropathy.

Muscle biopsy: inflammatory myopathy, mitochondrial disease, dystrophy; histochemistry and immunohistochemistry.

Lumbar puncture: opening pressure, cell count, glucose, protein, Gram stain, culture, PCR; contraindicated with raised ICP or coagulopathy.

Neonatal seizures: subtle, tonic, clonic, myoclonic; EEG monitoring required; treat with phenobarbital first-line.

Febrile seizures: age 6 months–5 years, simple <15 min generalized; no routine EEG or imaging; antipyretics do not prevent recurrence.

Cerebral palsy: non-progressive motor impairment, spastic/dyskinetic/ataxic types; MRI for etiology; multidisciplinary rehabilitation.

Developmental delay: global vs specific; genetic testing (microarray, exome), metabolic screen, hearing/vision assessment.

Neural tube defects: folic acid supplementation prevents; myelomeningocele requires surgical closure and hydrocephalus monitoring.

Childhood epilepsy syndromes: benign rolandic (centrotemporal spikes), childhood absence, West syndrome (infantile spasms, hypsarrhythmia), Lennox-Gastaut.

Head injury in children: PECARN criteria guide CT; avoid unnecessary radiation; observe for vomiting, LOC, skull fracture.

Inborn errors of metabolism: acute encephalopathy, hypoglycemia, hyperammonemia; urgent metabolic screen and treatment.

Delirium: acute fluctuating attention and awareness; screen with CAM; treat underlying cause, avoid antipsychotics unless agitation.

Dementia: progressive cognitive decline affecting function; MMSE/MoCA screening; differentiate Alzheimer, vascular, Lewy body, frontotemporal.

Aphasia types: Broca (non-fluent, repetition impaired, comprehension intact); Wernicke (fluent, comprehension impaired, repetition impaired); conduction (repetition impaired only).

Frontal lobe syndrome: disinhibition, apathy, perseveration, poor planning; assess with executive tasks (Stroop, trail making).

Depression in neurological disease: screen with PHQ-9; treat with SSRIs; avoid tricyclics in elderly with cognitive impairment.

Psychosis in Parkinson disease: reduce dopaminergic drugs first, then quetiapine or clozapine; avoid typical antipsychotics.

Capgras syndrome: delusion of impostor; associated with right hemisphere and frontal dysfunction.

Neuropsychological assessment: standardized tests for memory, attention, language, visuospatial, executive function; interpret with premorbid estimate.

Antiepileptic drugs: enzyme inducers (carbamazepine, phenytoin, phenobarbital) reduce levels of oral contraceptives, warfarin, other AEDs.

Levetiracetam: renally cleared, few interactions; adverse effects irritability, behavioral change.

Lamotrigine: slow titration to avoid Stevens-Johnson syndrome; interacts with valproate (increase level).

Parkinson drugs: levodopa/carbidopa with peripheral decarboxylase inhibitor; COMT inhibitors (entacapone) and MAO-B inhibitors (rasagiline) extend effect.

Dopamine agonists: impulse control disorders; ergot agonists cause fibrosis.

MS DMTs: interferons, glatiramer, teriflunomide, dimethyl fumarate, natalizumab (JC virus risk), ocrelizumab, alemtuzumab.

Evidence hierarchy: systematic reviews/meta-analyses > RCTs > cohort > case-control > case series; GRADE for recommendation strength.

Therapeutic drug monitoring: phenytoin (nonlinear kinetics), lithium, valproate, carbamazepine; interpret with timing and clinical context.

Informed consent: capacity, adequate information, voluntariness; document discussion of risks, benefits, alternatives.

Mental Capacity Act: presume capacity; assess understanding, retention, weighing, communication; best interests if lacking capacity.

Confidentiality: disclose only with consent or legal obligation; exceptions include public safety, notifiable diseases, court order.

Duty of candour: disclose harm promptly, apologize, explain, and support patient; statutory in UK.

Driving regulations: DVLA notification for seizures, syncope, dementia, visual field defects; advise patient to inform DVLA.

Fitness to practise: GMC standards; report concerns about colleagues; maintain competence and reflective practice.

Patient safety: incident reporting, root cause analysis, WHO surgical safety checklist, medication reconciliation.

End-of-life: advance decisions, DNACPR discussions, palliative care; respect patient wishes and involve family.

Corticospinal tract decussates at the medullary pyramid; lesion above = contralateral weakness, below = ipsilateral.

Internal capsule: anterior limb (thalamocortical), genu (corticobulbar), posterior limb (corticospinal, sensory); lacunar infarcts cause pure motor syndromes.

Broca area = inferior frontal gyrus (Brodmann 44/45); Wernicke area = posterior superior temporal gyrus (area 22).

Homunculus: leg medial (ACA), face lateral (MCA); foot area supplied by ACA.

Cranial nerve nuclei: III/IV midbrain, V–VIII pons, IX–XII medulla; CN VI exits at pontomedullary junction.

Cerebellar signs are ipsilateral: vermis = truncal ataxia; hemisphere = limb dysmetria; flocculonodular = nystagmus/gait.

Circle of Willis: A1, M1, P1 segments; anterior communicating connects ACAs, posterior communicating connects ICA to PCA.

Resting membrane potential ≈ −70 mV, set mainly by K+ conductance; Nernst equation E = 61.5·log([K]o/[K]i).

Action potential threshold ≈ −55 mV; depolarization by Na+ influx, repolarization by K+ efflux; refractory period from Na+ channel inactivation.

Myelinated conduction velocity ≈ 6 × axon diameter (m/s); demyelination slows conduction and disperses the compound action potential.

Synaptic transmission: Ca2+ influx → vesicle fusion (SNARE) → neurotransmitter release; GABA-A is Cl− channel (inhibitory), NMDA is Ca2+/Na+ (excitatory).

Cerebral blood flow ≈ 50 mL/100 g/min; autoregulation 60–160 mmHg MAP; CBF <20 causes EEG slowing, <10 causes infarction.

CSF: produced by choroid plexus ~500 mL/day, total volume ~150 mL, turnover 3–4×/day; normal opening pressure 10–20 cm H2O.

EEG rhythms: alpha 8–13 Hz occipital (eyes closed), beta >13 Hz frontal, theta 4–7 Hz, delta <4 Hz.

Dopamine pathways: nigrostriatal (motor), mesolimbic/mesocortical (reward, psychosis), tuberoinfundibular (prolactin inhibition).

Localization sequence: cortical → subcortical → brainstem → spinal cord → root/plexus → peripheral nerve → neuromuscular junction → muscle.

UMN lesion: spasticity, hyperreflexia, Babinski present, no fasciculations; LMN: flaccidity, atrophy, fasciculations, areflexia.

Sensory level on trunk localizes cord lesion ~1–2 segments above the level; Brown-Séquard = ipsilateral proprioceptive/motor loss + contralateral pain/temperature loss.

Cranial nerve pattern: crossed signs (ipsilateral face, contralateral body) localize to brainstem; bilateral signs suggest neuromuscular or systemic cause.

Unexplained coma: check pupils (pinpoint = pontine/opioid; fixed dilated = herniation/anticholinergic) and oculocephalic reflex.

Sudden-onset focal deficit = vascular until proven otherwise; thunderclap headache = SAH; progressive deficit over days = tumor, abscess, or inflammatory.

Aphasia vs dysarthria: aphasia impairs comprehension/naming and writing; dysarthria affects articulation with preserved language.

Red flags in headache: age >50, new onset, thunderclap, fever, papilledema, focal deficit, cancer, immunosuppression, positional change.

Ischemic stroke thrombolysis: alteplase/tenecteplase within 4.5 h of last known well; door-to-needle target <60 min.

Thrombectomy: large-vessel occlusion (ICA, M1, basilar) within 6 h, or 6–24 h with salvageable penumbra on perfusion/CT.

ASPECTS score: 10-point CT scoring; ≤6 predicts poor outcome and limits thrombectomy benefit.

ICH: BP lowering to systolic 130–140 mmHg within 6 h (INTERACT2/ATACH-II); reverse anticoagulation immediately; no routine steroids.

Aneurysmal SAH: CT within 6 h highly sensitive; if negative and suspicion high, LP for xanthochromia; nimodipine 60 mg q4h for 21 days.

Malignant MCA infarction: decompressive hemicraniectomy within 48 h in patients <60 years reduces mortality and improves outcome.

Neurocritical care: target PaO2 70–100 mmHg, normocapnia (PaCO2 35–40), normonatremia, normoglycemia, head of bed 30°.

Cerebral autoregulation is impaired in acute injury; avoid hypotension; CPP = MAP − ICP, target 60–70 mmHg in TBI.

Seizure classification: focal (aware/impaired awareness, focal to bilateral tonic-clonic) vs generalized (absence, myoclonic, tonic-clonic, atonic).

First-line: focal = levetiracetam, lamotrigine, carbamazepine; generalized tonic-clonic = valproate, levetiracetam, lamotrigine; absence = ethosuximide/valproate.

Valproate contraindicated in pregnancy (neural tube defects, neurodevelopmental harm); avoid in women of childbearing age.

Status epilepticus: benzodiazepine first-line, then levetiracetam, valproate, or phenytoin; refractory = anesthetic infusion (midazolam, propofol, thiopental).

EEG in absence: 3 Hz spike-and-wave, hyperventilation provokes; in Lennox-Gastaut: slow spike-and-wave (1.5–2.5 Hz).

Sleep: OSA diagnosed by AHI ≥5 with symptoms or ≥15 regardless; first-line CPAP; avoid sedatives.

Narcolepsy: MSLT mean sleep latency <8 min with ≥2 SOREMPs; cataplexy, hypnagogic hallucinations, sleep paralysis.

Driving: UK DVLA requires 12 months seizure-free for group 1 license after a first unprovoked seizure; 6 months after a provoked seizure.

Myasthenia gravis: fatigable weakness, ptosis/diplopia, anti-AChR or anti-MuSK; treat with pyridostigmine, steroids, azathioprine, thymectomy.

Lambert-Eaton: proximal weakness, hyporeflexia, autonomic features; anti-VGCC; associated with small cell lung cancer.

Guillain-Barré: ascending symmetric weakness, areflexia, albuminocytologic dissociation; IVIG or plasma exchange; monitor vital capacity.

Duchenne muscular dystrophy: X-linked dystrophin mutation, Gowers sign, calf pseudohypertrophy, elevated CK; steroids slow progression.

ALS: UMN + LMN signs, fasciculations, no sensory loss; riluzole and edaravone modest benefit; noninvasive ventilation for respiratory failure.

Myotonic dystrophy type 1: CTG repeat expansion, myotonia, cataracts, cardiac conduction defects, diabetes; monitor ECG.

Periodic paralysis: hypokalemic (channelopathy) responds to potassium; hyperkalemic to acetazolamide; avoid triggers.

Botulism: descending weakness, autonomic dysfunction, presynaptic block; antitoxin and supportive care.

Length-dependent neuropathy: stocking-glove sensory loss, reduced ankle reflexes; causes diabetes, alcohol, B12 deficiency, hypothyroidism, CKD.

NCS/EMG: demyelinating = slowed conduction velocity, prolonged distal latency, conduction block; axonal = reduced amplitude.

CIDP: progressive/relapsing, proximal and distal weakness, areflexia, CSF protein elevated; treat with IVIG, steroids, plasma exchange.

Rehabilitation after stroke: task-specific repetitive training, constraint-induced movement therapy for upper limb, early mobilization.

Spasticity: botulinum toxin for focal, baclofen (oral or intrathecal) for generalized; physiotherapy adjunct.

Neuropathic pain: gabapentin, pregabalin, duloxetine, amitriptyline first-line; opioids not recommended.

Pressure injury prevention: reposition every 2 h, skin inspection, nutritional support; spinal cord injury patients at high risk.

Brachial plexus: upper (Erb) C5–C6 = arm adducted, internally rotated; lower (Klumpke) C8–T1 = claw hand, Horner syndrome.

Multiple sclerosis: dissemination in space and time (McDonald criteria); CSF oligoclonal bands; MRI periventricular, juxtacortical, infratentorial, spinal cord lesions.

MS relapse: high-dose IV methylprednisolone 1 g daily for 3–5 days; disease-modifying therapy for relapsing-remitting disease.

Neuromyelitis optica spectrum disorder: anti-AQP4, longitudinally extensive transverse myelitis, optic neuritis; treat with rituximab, eculizumab, inebilizumab.

MOG antibody disease: optic neuritis, ADEM-like, transverse myelitis; often steroid-responsive; avoid certain MS DMTs.

Autoimmune encephalitis: anti-NMDAR (psychiatric onset, dyskinesias, ovarian teratoma), anti-LGI1 (faciobrachial dystonic seizures, hyponatremia).

Acute disseminated encephalomyelitis (ADEM): post-infectious, multifocal white matter lesions, children more common; steroids.

Anti-NMDAR encephalitis: CSF pleocytosis, EEG extreme delta brush; treat with steroids, IVIG/plasma exchange, tumor removal.

MS mimics: sarcoidosis, lupus, Sjögren, Behçet, CADASIL, vitamin B12 deficiency, HTLV-1.

Bacterial meningitis: CSF neutrophilic pleocytosis, low glucose, high protein; empiric ceftriaxone + vancomycin ± ampicillin (Listeria if >50 or immunocompromised).

Viral meningitis: lymphocytic pleocytosis, normal glucose; enterovirus most common; supportive care.

HSV encephalitis: temporal lobe involvement, hemorrhagic necrosis; IV aciclovir 10 mg/kg q8h for 14–21 days; start empirically.

TB meningitis: basal meningeal enhancement, hydrocephalus, low glucose; treat with 4-drug regimen plus steroids in HIV-negative.

HIV-associated neurocognitive disorder: screen with cognitive testing; ART is mainstay; CNS opportunistic infections depend on CD4 count.

Neurosyphilis: CSF VDRL, pleocytosis, elevated protein; treat with IV penicillin G 18–24 million units/day for 10–14 days.

Brain abscess: ring-enhancing lesion, source from dental/sinus/ear or hematogenous; aspirate for culture, antibiotics 6–8 weeks.

Prion disease (CJD): rapidly progressive dementia, myoclonus, periodic sharp wave complexes on EEG, elevated 14-3-3; no treatment.

Parkinson disease: bradykinesia + rigidity or rest tremor; levodopa/carbidopa is most effective; motor complications after 5–10 years.

Atypical parkinsonism: MSA (autonomic failure), PSP (vertical gaze palsy, falls), CBD (asymmetric cortical signs), DLB (fluctuating cognition, hallucinations).

Essential tremor: bilateral postural/kinetic tremor, improves with propranolol or primidone; alcohol-responsive.

Huntington disease: CAG repeat expansion, chorea, psychiatric features, dementia; autosomal dominant.

Alzheimer disease: episodic memory loss, medial temporal atrophy; cholinesterase inhibitors for mild-moderate, memantine for moderate-severe.

Frontotemporal dementia: behavioral variant (disinhibition, apathy) or language variant (PPA); MAPT, GRN, C9orf72 mutations.

Dystonia: focal (cervical, blepharospasm) treated with botulinum toxin; generalized may respond to deep brain stimulation.

Restless legs syndrome: urge to move, worse at rest/evening, relieved by movement; iron deficiency and dopamine agonists.

Migraine: unilateral, pulsating, 4–72 h, nausea, photophobia; acute triptans + NSAIDs; prophylaxis propranolol, topiramate, amitriptyline, CGRP monoclonal antibodies.

Tension-type headache: bilateral, pressing, mild-moderate, no nausea; NSAIDs/paracetamol; amitriptyline for prophylaxis.

Cluster headache: severe unilateral orbital pain with autonomic features, 15–180 min; high-flow oxygen + subcutaneous sumatriptan; verapamil prophylaxis.

Trigeminal neuralgia: lancinating facial pain in V2/V3; carbamazepine first-line; microvascular decompression if refractory.

Medication-overuse headache: headache ≥15 days/month with analgesic overuse; withdrawal and prophylaxis.

Giant cell arteritis: age >50, temporal tenderness, elevated ESR/CRP, jaw claudication; high-dose steroids immediately, biopsy.

Idiopathic intracranial hypertension: papilledema, headache, visual obscurations; acetazolamide, weight loss, shunt if vision threatened.

Postherpetic neuralgia: gabapentin, pregabalin, lidocaine patch, amitriptyline; prevention with zoster vaccine.

CT head: first-line for acute hemorrhage, trauma, raised ICP; hyperdense acute blood, hypodense ischemia after 6–12 h.

MRI DWI: most sensitive for acute infarction within minutes; restricted diffusion also in abscess, CJD, hypercellular tumors.

MRI T2/FLAIR: edema, demyelination, gliosis; T1 post-contrast: blood-brain barrier breakdown, tumors, infection.

Vascular imaging: CTA/MRA for large-vessel occlusion and aneurysm; DSA is gold standard for vasculitis and arteriovenous malformations.

Perfusion imaging (CTP/MRP): identifies penumbra for late-window thrombectomy; mismatch between core and hypoperfused tissue.

Spinal imaging: MRI with contrast for cord compression, abscess, tumor; CT for bony trauma.

PET: FDG for tumor grading and dementia; amyloid PET for Alzheimer pathology; DAT scan for parkinsonism.

Caution: gadolinium in renal impairment (NSF risk with older agents), and in pregnancy use only if essential.

EEG: 10–20 system electrode placement; referential or bipolar montage; standard 30-min recording, sleep deprivation and photic stimulation activate epileptiform discharges.

Epileptiform discharges: spikes, sharp waves, spike-and-wave; 3 Hz generalized = absence; temporal spikes = focal epilepsy.

EMG: insertional activity, spontaneous activity (fibrillations, positive sharp waves = denervation), motor unit potentials (large = chronic reinnervation).

NCS: sensory and motor amplitudes, conduction velocity, distal latency, F waves; compare with normal reference values and contralateral side.

Evoked potentials: VEP (demyelination, optic neuritis), BAEP (brainstem lesions), SEP (cord, plexus).

Nerve biopsy: reserved for suspected vasculitis, amyloid, leprosy, or unexplained progressive neuropathy.

Muscle biopsy: inflammatory myopathy, mitochondrial disease, dystrophy; histochemistry and immunohistochemistry.

Lumbar puncture: opening pressure, cell count, glucose, protein, Gram stain, culture, PCR; contraindicated with raised ICP or coagulopathy.

Neonatal seizures: subtle, tonic, clonic, myoclonic; EEG monitoring required; treat with phenobarbital first-line.

Febrile seizures: age 6 months–5 years, simple <15 min generalized; no routine EEG or imaging; antipyretics do not prevent recurrence.

Cerebral palsy: non-progressive motor impairment, spastic/dyskinetic/ataxic types; MRI for etiology; multidisciplinary rehabilitation.

Developmental delay: global vs specific; genetic testing (microarray, exome), metabolic screen, hearing/vision assessment.

Neural tube defects: folic acid supplementation prevents; myelomeningocele requires surgical closure and hydrocephalus monitoring.

Childhood epilepsy syndromes: benign rolandic (centrotemporal spikes), childhood absence, West syndrome (infantile spasms, hypsarrhythmia), Lennox-Gastaut.

Head injury in children: PECARN criteria guide CT; avoid unnecessary radiation; observe for vomiting, LOC, skull fracture.

Inborn errors of metabolism: acute encephalopathy, hypoglycemia, hyperammonemia; urgent metabolic screen and treatment.

Delirium: acute fluctuating attention and awareness; screen with CAM; treat underlying cause, avoid antipsychotics unless agitation.

Dementia: progressive cognitive decline affecting function; MMSE/MoCA screening; differentiate Alzheimer, vascular, Lewy body, frontotemporal.

Aphasia types: Broca (non-fluent, repetition impaired, comprehension intact); Wernicke (fluent, comprehension impaired, repetition impaired); conduction (repetition impaired only).

Frontal lobe syndrome: disinhibition, apathy, perseveration, poor planning; assess with executive tasks (Stroop, trail making).

Depression in neurological disease: screen with PHQ-9; treat with SSRIs; avoid tricyclics in elderly with cognitive impairment.

Psychosis in Parkinson disease: reduce dopaminergic drugs first, then quetiapine or clozapine; avoid typical antipsychotics.

Capgras syndrome: delusion of impostor; associated with right hemisphere and frontal dysfunction.

Neuropsychological assessment: standardized tests for memory, attention, language, visuospatial, executive function; interpret with premorbid estimate.

Antiepileptic drugs: enzyme inducers (carbamazepine, phenytoin, phenobarbital) reduce levels of oral contraceptives, warfarin, other AEDs.

Levetiracetam: renally cleared, few interactions; adverse effects irritability, behavioral change.

Lamotrigine: slow titration to avoid Stevens-Johnson syndrome; interacts with valproate (increase level).

Parkinson drugs: levodopa/carbidopa with peripheral decarboxylase inhibitor; COMT inhibitors (entacapone) and MAO-B inhibitors (rasagiline) extend effect.

Dopamine agonists: impulse control disorders; ergot agonists cause fibrosis.

MS DMTs: interferons, glatiramer, teriflunomide, dimethyl fumarate, natalizumab (JC virus risk), ocrelizumab, alemtuzumab.

Evidence hierarchy: systematic reviews/meta-analyses > RCTs > cohort > case-control > case series; GRADE for recommendation strength.

Therapeutic drug monitoring: phenytoin (nonlinear kinetics), lithium, valproate, carbamazepine; interpret with timing and clinical context.

Informed consent: capacity, adequate information, voluntariness; document discussion of risks, benefits, alternatives.

Mental Capacity Act: presume capacity; assess understanding, retention, weighing, communication; best interests if lacking capacity.

Confidentiality: disclose only with consent or legal obligation; exceptions include public safety, notifiable diseases, court order.

Duty of candour: disclose harm promptly, apologize, explain, and support patient; statutory in UK.

Driving regulations: DVLA notification for seizures, syncope, dementia, visual field defects; advise patient to inform DVLA.

Fitness to practise: GMC standards; report concerns about colleagues; maintain competence and reflective practice.

Patient safety: incident reporting, root cause analysis, WHO surgical safety checklist, medication reconciliation.

End-of-life: advance decisions, DNACPR discussions, palliative care; respect patient wishes and involve family.

Corticospinal tract decussates at the medullary pyramid; lesion above = contralateral weakness, below = ipsilateral.

Internal capsule: anterior limb (thalamocortical), genu (corticobulbar), posterior limb (corticospinal, sensory); lacunar infarcts cause pure motor syndromes.

Broca area = inferior frontal gyrus (Brodmann 44/45); Wernicke area = posterior superior temporal gyrus (area 22).

Homunculus: leg medial (ACA), face lateral (MCA); foot area supplied by ACA.

Cranial nerve nuclei: III/IV midbrain, V–VIII pons, IX–XII medulla; CN VI exits at pontomedullary junction.

Cerebellar signs are ipsilateral: vermis = truncal ataxia; hemisphere = limb dysmetria; flocculonodular = nystagmus/gait.

Circle of Willis: A1, M1, P1 segments; anterior communicating connects ACAs, posterior communicating connects ICA to PCA.

Resting membrane potential ≈ −70 mV, set mainly by K+ conductance; Nernst equation E = 61.5·log([K]o/[K]i).

Action potential threshold ≈ −55 mV; depolarization by Na+ influx, repolarization by K+ efflux; refractory period from Na+ channel inactivation.

Myelinated conduction velocity ≈ 6 × axon diameter (m/s); demyelination slows conduction and disperses the compound action potential.

Synaptic transmission: Ca2+ influx → vesicle fusion (SNARE) → neurotransmitter release; GABA-A is Cl− channel (inhibitory), NMDA is Ca2+/Na+ (excitatory).

Cerebral blood flow ≈ 50 mL/100 g/min; autoregulation 60–160 mmHg MAP; CBF <20 causes EEG slowing, <10 causes infarction.

CSF: produced by choroid plexus ~500 mL/day, total volume ~150 mL, turnover 3–4×/day; normal opening pressure 10–20 cm H2O.

EEG rhythms: alpha 8–13 Hz occipital (eyes closed), beta >13 Hz frontal, theta 4–7 Hz, delta <4 Hz.

Dopamine pathways: nigrostriatal (motor), mesolimbic/mesocortical (reward, psychosis), tuberoinfundibular (prolactin inhibition).

Localization sequence: cortical → subcortical → brainstem → spinal cord → root/plexus → peripheral nerve → neuromuscular junction → muscle.

UMN lesion: spasticity, hyperreflexia, Babinski present, no fasciculations; LMN: flaccidity, atrophy, fasciculations, areflexia.

Sensory level on trunk localizes cord lesion ~1–2 segments above the level; Brown-Séquard = ipsilateral proprioceptive/motor loss + contralateral pain/temperature loss.

Cranial nerve pattern: crossed signs (ipsilateral face, contralateral body) localize to brainstem; bilateral signs suggest neuromuscular or systemic cause.

Unexplained coma: check pupils (pinpoint = pontine/opioid; fixed dilated = herniation/anticholinergic) and oculocephalic reflex.

Sudden-onset focal deficit = vascular until proven otherwise; thunderclap headache = SAH; progressive deficit over days = tumor, abscess, or inflammatory.

Aphasia vs dysarthria: aphasia impairs comprehension/naming and writing; dysarthria affects articulation with preserved language.

Red flags in headache: age >50, new onset, thunderclap, fever, papilledema, focal deficit, cancer, immunosuppression, positional change.

Ischemic stroke thrombolysis: alteplase/tenecteplase within 4.5 h of last known well; door-to-needle target <60 min.

Thrombectomy: large-vessel occlusion (ICA, M1, basilar) within 6 h, or 6–24 h with salvageable penumbra on perfusion/CT.

ASPECTS score: 10-point CT scoring; ≤6 predicts poor outcome and limits thrombectomy benefit.

ICH: BP lowering to systolic 130–140 mmHg within 6 h (INTERACT2/ATACH-II); reverse anticoagulation immediately; no routine steroids.

Aneurysmal SAH: CT within 6 h highly sensitive; if negative and suspicion high, LP for xanthochromia; nimodipine 60 mg q4h for 21 days.

Malignant MCA infarction: decompressive hemicraniectomy within 48 h in patients <60 years reduces mortality and improves outcome.

Neurocritical care: target PaO2 70–100 mmHg, normocapnia (PaCO2 35–40), normonatremia, normoglycemia, head of bed 30°.

Cerebral autoregulation is impaired in acute injury; avoid hypotension; CPP = MAP − ICP, target 60–70 mmHg in TBI.

Seizure classification: focal (aware/impaired awareness, focal to bilateral tonic-clonic) vs generalized (absence, myoclonic, tonic-clonic, atonic).

First-line: focal = levetiracetam, lamotrigine, carbamazepine; generalized tonic-clonic = valproate, levetiracetam, lamotrigine; absence = ethosuximide/valproate.

Valproate contraindicated in pregnancy (neural tube defects, neurodevelopmental harm); avoid in women of childbearing age.

Status epilepticus: benzodiazepine first-line, then levetiracetam, valproate, or phenytoin; refractory = anesthetic infusion (midazolam, propofol, thiopental).

EEG in absence: 3 Hz spike-and-wave, hyperventilation provokes; in Lennox-Gastaut: slow spike-and-wave (1.5–2.5 Hz).

Sleep: OSA diagnosed by AHI ≥5 with symptoms or ≥15 regardless; first-line CPAP; avoid sedatives.

Narcolepsy: MSLT mean sleep latency <8 min with ≥2 SOREMPs; cataplexy, hypnagogic hallucinations, sleep paralysis.

Driving: UK DVLA requires 12 months seizure-free for group 1 license after a first unprovoked seizure; 6 months after a provoked seizure.

Myasthenia gravis: fatigable weakness, ptosis/diplopia, anti-AChR or anti-MuSK; treat with pyridostigmine, steroids, azathioprine, thymectomy.

Lambert-Eaton: proximal weakness, hyporeflexia, autonomic features; anti-VGCC; associated with small cell lung cancer.

Guillain-Barré: ascending symmetric weakness, areflexia, albuminocytologic dissociation; IVIG or plasma exchange; monitor vital capacity.

Duchenne muscular dystrophy: X-linked dystrophin mutation, Gowers sign, calf pseudohypertrophy, elevated CK; steroids slow progression.

ALS: UMN + LMN signs, fasciculations, no sensory loss; riluzole and edaravone modest benefit; noninvasive ventilation for respiratory failure.

Myotonic dystrophy type 1: CTG repeat expansion, myotonia, cataracts, cardiac conduction defects, diabetes; monitor ECG.

Periodic paralysis: hypokalemic (channelopathy) responds to potassium; hyperkalemic to acetazolamide; avoid triggers.

Botulism: descending weakness, autonomic dysfunction, presynaptic block; antitoxin and supportive care.

Length-dependent neuropathy: stocking-glove sensory loss, reduced ankle reflexes; causes diabetes, alcohol, B12 deficiency, hypothyroidism, CKD.

NCS/EMG: demyelinating = slowed conduction velocity, prolonged distal latency, conduction block; axonal = reduced amplitude.

CIDP: progressive/relapsing, proximal and distal weakness, areflexia, CSF protein elevated; treat with IVIG, steroids, plasma exchange.

Rehabilitation after stroke: task-specific repetitive training, constraint-induced movement therapy for upper limb, early mobilization.

Spasticity: botulinum toxin for focal, baclofen (oral or intrathecal) for generalized; physiotherapy adjunct.

Neuropathic pain: gabapentin, pregabalin, duloxetine, amitriptyline first-line; opioids not recommended.

Pressure injury prevention: reposition every 2 h, skin inspection, nutritional support; spinal cord injury patients at high risk.

Brachial plexus: upper (Erb) C5–C6 = arm adducted, internally rotated; lower (Klumpke) C8–T1 = claw hand, Horner syndrome.

Multiple sclerosis: dissemination in space and time (McDonald criteria); CSF oligoclonal bands; MRI periventricular, juxtacortical, infratentorial, spinal cord lesions.

MS relapse: high-dose IV methylprednisolone 1 g daily for 3–5 days; disease-modifying therapy for relapsing-remitting disease.

Neuromyelitis optica spectrum disorder: anti-AQP4, longitudinally extensive transverse myelitis, optic neuritis; treat with rituximab, eculizumab, inebilizumab.

MOG antibody disease: optic neuritis, ADEM-like, transverse myelitis; often steroid-responsive; avoid certain MS DMTs.

Autoimmune encephalitis: anti-NMDAR (psychiatric onset, dyskinesias, ovarian teratoma), anti-LGI1 (faciobrachial dystonic seizures, hyponatremia).

Acute disseminated encephalomyelitis (ADEM): post-infectious, multifocal white matter lesions, children more common; steroids.

Anti-NMDAR encephalitis: CSF pleocytosis, EEG extreme delta brush; treat with steroids, IVIG/plasma exchange, tumor removal.

MS mimics: sarcoidosis, lupus, Sjögren, Behçet, CADASIL, vitamin B12 deficiency, HTLV-1.

Bacterial meningitis: CSF neutrophilic pleocytosis, low glucose, high protein; empiric ceftriaxone + vancomycin ± ampicillin (Listeria if >50 or immunocompromised).

Viral meningitis: lymphocytic pleocytosis, normal glucose; enterovirus most common; supportive care.

HSV encephalitis: temporal lobe involvement, hemorrhagic necrosis; IV aciclovir 10 mg/kg q8h for 14–21 days; start empirically.

TB meningitis: basal meningeal enhancement, hydrocephalus, low glucose; treat with 4-drug regimen plus steroids in HIV-negative.

HIV-associated neurocognitive disorder: screen with cognitive testing; ART is mainstay; CNS opportunistic infections depend on CD4 count.

Neurosyphilis: CSF VDRL, pleocytosis, elevated protein; treat with IV penicillin G 18–24 million units/day for 10–14 days.

Brain abscess: ring-enhancing lesion, source from dental/sinus/ear or hematogenous; aspirate for culture, antibiotics 6–8 weeks.

Prion disease (CJD): rapidly progressive dementia, myoclonus, periodic sharp wave complexes on EEG, elevated 14-3-3; no treatment.

Parkinson disease: bradykinesia + rigidity or rest tremor; levodopa/carbidopa is most effective; motor complications after 5–10 years.

Atypical parkinsonism: MSA (autonomic failure), PSP (vertical gaze palsy, falls), CBD (asymmetric cortical signs), DLB (fluctuating cognition, hallucinations).

Essential tremor: bilateral postural/kinetic tremor, improves with propranolol or primidone; alcohol-responsive.

Huntington disease: CAG repeat expansion, chorea, psychiatric features, dementia; autosomal dominant.

Alzheimer disease: episodic memory loss, medial temporal atrophy; cholinesterase inhibitors for mild-moderate, memantine for moderate-severe.

Frontotemporal dementia: behavioral variant (disinhibition, apathy) or language variant (PPA); MAPT, GRN, C9orf72 mutations.

Dystonia: focal (cervical, blepharospasm) treated with botulinum toxin; generalized may respond to deep brain stimulation.

Restless legs syndrome: urge to move, worse at rest/evening, relieved by movement; iron deficiency and dopamine agonists.

Migraine: unilateral, pulsating, 4–72 h, nausea, photophobia; acute triptans + NSAIDs; prophylaxis propranolol, topiramate, amitriptyline, CGRP monoclonal antibodies.

Tension-type headache: bilateral, pressing, mild-moderate, no nausea; NSAIDs/paracetamol; amitriptyline for prophylaxis.

Cluster headache: severe unilateral orbital pain with autonomic features, 15–180 min; high-flow oxygen + subcutaneous sumatriptan; verapamil prophylaxis.

Trigeminal neuralgia: lancinating facial pain in V2/V3; carbamazepine first-line; microvascular decompression if refractory.

Medication-overuse headache: headache ≥15 days/month with analgesic overuse; withdrawal and prophylaxis.

Giant cell arteritis: age >50, temporal tenderness, elevated ESR/CRP, jaw claudication; high-dose steroids immediately, biopsy.

Idiopathic intracranial hypertension: papilledema, headache, visual obscurations; acetazolamide, weight loss, shunt if vision threatened.

Postherpetic neuralgia: gabapentin, pregabalin, lidocaine patch, amitriptyline; prevention with zoster vaccine.

CT head: first-line for acute hemorrhage, trauma, raised ICP; hyperdense acute blood, hypodense ischemia after 6–12 h.

MRI DWI: most sensitive for acute infarction within minutes; restricted diffusion also in abscess, CJD, hypercellular tumors.

MRI T2/FLAIR: edema, demyelination, gliosis; T1 post-contrast: blood-brain barrier breakdown, tumors, infection.

Vascular imaging: CTA/MRA for large-vessel occlusion and aneurysm; DSA is gold standard for vasculitis and arteriovenous malformations.

Perfusion imaging (CTP/MRP): identifies penumbra for late-window thrombectomy; mismatch between core and hypoperfused tissue.

Spinal imaging: MRI with contrast for cord compression, abscess, tumor; CT for bony trauma.

PET: FDG for tumor grading and dementia; amyloid PET for Alzheimer pathology; DAT scan for parkinsonism.

Caution: gadolinium in renal impairment (NSF risk with older agents), and in pregnancy use only if essential.

EEG: 10–20 system electrode placement; referential or bipolar montage; standard 30-min recording, sleep deprivation and photic stimulation activate epileptiform discharges.

Epileptiform discharges: spikes, sharp waves, spike-and-wave; 3 Hz generalized = absence; temporal spikes = focal epilepsy.

EMG: insertional activity, spontaneous activity (fibrillations, positive sharp waves = denervation), motor unit potentials (large = chronic reinnervation).

NCS: sensory and motor amplitudes, conduction velocity, distal latency, F waves; compare with normal reference values and contralateral side.

Evoked potentials: VEP (demyelination, optic neuritis), BAEP (brainstem lesions), SEP (cord, plexus).

Nerve biopsy: reserved for suspected vasculitis, amyloid, leprosy, or unexplained progressive neuropathy.

Muscle biopsy: inflammatory myopathy, mitochondrial disease, dystrophy; histochemistry and immunohistochemistry.

Lumbar puncture: opening pressure, cell count, glucose, protein, Gram stain, culture, PCR; contraindicated with raised ICP or coagulopathy.

Neonatal seizures: subtle, tonic, clonic, myoclonic; EEG monitoring required; treat with phenobarbital first-line.

Febrile seizures: age 6 months–5 years, simple <15 min generalized; no routine EEG or imaging; antipyretics do not prevent recurrence.

Cerebral palsy: non-progressive motor impairment, spastic/dyskinetic/ataxic types; MRI for etiology; multidisciplinary rehabilitation.

Developmental delay: global vs specific; genetic testing (microarray, exome), metabolic screen, hearing/vision assessment.

Neural tube defects: folic acid supplementation prevents; myelomeningocele requires surgical closure and hydrocephalus monitoring.

Childhood epilepsy syndromes: benign rolandic (centrotemporal spikes), childhood absence, West syndrome (infantile spasms, hypsarrhythmia), Lennox-Gastaut.

Head injury in children: PECARN criteria guide CT; avoid unnecessary radiation; observe for vomiting, LOC, skull fracture.

Inborn errors of metabolism: acute encephalopathy, hypoglycemia, hyperammonemia; urgent metabolic screen and treatment.

Delirium: acute fluctuating attention and awareness; screen with CAM; treat underlying cause, avoid antipsychotics unless agitation.

Dementia: progressive cognitive decline affecting function; MMSE/MoCA screening; differentiate Alzheimer, vascular, Lewy body, frontotemporal.

Aphasia types: Broca (non-fluent, repetition impaired, comprehension intact); Wernicke (fluent, comprehension impaired, repetition impaired); conduction (repetition impaired only).

Frontal lobe syndrome: disinhibition, apathy, perseveration, poor planning; assess with executive tasks (Stroop, trail making).

Depression in neurological disease: screen with PHQ-9; treat with SSRIs; avoid tricyclics in elderly with cognitive impairment.

Psychosis in Parkinson disease: reduce dopaminergic drugs first, then quetiapine or clozapine; avoid typical antipsychotics.

Capgras syndrome: delusion of impostor; associated with right hemisphere and frontal dysfunction.

Neuropsychological assessment: standardized tests for memory, attention, language, visuospatial, executive function; interpret with premorbid estimate.

Antiepileptic drugs: enzyme inducers (carbamazepine, phenytoin, phenobarbital) reduce levels of oral contraceptives, warfarin, other AEDs.

Levetiracetam: renally cleared, few interactions; adverse effects irritability, behavioral change.

Lamotrigine: slow titration to avoid Stevens-Johnson syndrome; interacts with valproate (increase level).

Parkinson drugs: levodopa/carbidopa with peripheral decarboxylase inhibitor; COMT inhibitors (entacapone) and MAO-B inhibitors (rasagiline) extend effect.

Dopamine agonists: impulse control disorders; ergot agonists cause fibrosis.

MS DMTs: interferons, glatiramer, teriflunomide, dimethyl fumarate, natalizumab (JC virus risk), ocrelizumab, alemtuzumab.

Evidence hierarchy: systematic reviews/meta-analyses > RCTs > cohort > case-control > case series; GRADE for recommendation strength.

Therapeutic drug monitoring: phenytoin (nonlinear kinetics), lithium, valproate, carbamazepine; interpret with timing and clinical context.

Informed consent: capacity, adequate information, voluntariness; document discussion of risks, benefits, alternatives.

Mental Capacity Act: presume capacity; assess understanding, retention, weighing, communication; best interests if lacking capacity.

Confidentiality: disclose only with consent or legal obligation; exceptions include public safety, notifiable diseases, court order.

Duty of candour: disclose harm promptly, apologize, explain, and support patient; statutory in UK.

Driving regulations: DVLA notification for seizures, syncope, dementia, visual field defects; advise patient to inform DVLA.

Fitness to practise: GMC standards; report concerns about colleagues; maintain competence and reflective practice.

Patient safety: incident reporting, root cause analysis, WHO surgical safety checklist, medication reconciliation.

End-of-life: advance decisions, DNACPR discussions, palliative care; respect patient wishes and involve family.