Neurology: Stroke, Seizures, Headache and Neuromuscular Disease
Core concepts
Neurology requires a localisation-based approach to stroke, transient ischaemic attack, seizures and status epilepticus, headache, coma, meningitis, peripheral neuropathy, myasthenia gravis, multiple sclerosis and movement disorders. For stroke, know the time window for thrombolysis (up to 4.5 hours in eligible patients), blood pressure thresholds, thrombectomy selection and secondary prevention. Status epilepticus needs benzodiazepines first, then a second-line antiseizure drug. Headache red flags include thunderclap onset, fever, focal deficit, papilloedema and age over 50 with new headache.
Traps
Always check glucose in any acute neurological presentation; hypoglycaemia can mimic stroke. A normal early CT does not exclude ischaemic stroke. Subarachnoid haemorrhage may need lumbar puncture if CT is negative and suspicion remains. In myasthenia gravis, avoid aminoglycosides and other drugs that worsen neuromuscular transmission. Do not miss cauda equina syndrome: bilateral leg symptoms, saddle anaesthesia and bladder dysfunction need urgent MRI.
Worked example / rule of thumb
A patient has sudden severe headache and a normal CT at 6 hours. If suspicion for subarachnoid haemorrhage remains, perform lumbar puncture at least 12 hours after onset and look for xanthochromia. Rule: thunderclap headache with a negative early CT still requires further investigation.