Neurologic
What you must know
Stroke is the highest-yield topic. Sudden focal deficit gets a noncontrast CT to exclude hemorrhage and a glucose check; thrombolysis is considered within 4.5 hours of onset in eligible patients, and thrombectomy for large vessel occlusion in selected patients well beyond that window. A normal CT does not exclude ischemia. Transient ischemic attack demands urgent evaluation and secondary prevention. Subarachnoid hemorrhage presents as a thunderclap headache reaching maximum intensity in seconds; a negative early CT still warrants further workup if suspicion is high.
Headache red flags: thunderclap onset, fever with neck stiffness, positional worsening, papilledema, new headache after age 50, cancer or HIV, and jaw claudication with vision symptoms (giant cell arteritis - give steroids immediately, biopsy does not delay treatment). Migraine is treated acutely with an NSAID or triptan and prevented with beta-blockers, topiramate, or CGRP agents.
Seizures: status epilepticus is treated first with a benzodiazepine, then a second-line antiseizure drug. Parkinson disease shows asymmetric resting tremor, bradykinesia, rigidity, and response to levodopa. Peripheral neuropathy workup includes glucose, B12, and medication review. Delirium is acute, fluctuating, and inattentive; dementia is chronic and progressive. Wernicke encephalopathy (ataxia, ophthalmoplegia, confusion) requires immediate thiamine.
Traps
- Giving thrombolytics without a glucose check.
- Treating a new headache as sinus disease in an older adult.
- Reassuring after a normal CT in suspected subarachnoid hemorrhage.
- Starting an antiseizure drug before a benzodiazepine in status epilepticus.
Rule of thumb
Every acute neurologic presentation gets a bedside glucose before anything else - hypoglycemia is the great stroke mimic.