Neurology

A

• Acute Ischemic Stroke — Door‑to‑Needle, Door‑to‑Groin, and Post‑Reperfusion Care

  Rapid triage by last‑known‑well and stroke severity, non‑contrast CT to exclude hemorrhage, CTA for LVO, IV alteplase within 4.5 h when eligible, and mechanical thrombectomy up to 24 h in selected patients; strict BP and neuro monitoring after reperfusion.
• Acute Ischemic Stroke — ED to Reperfusion

  FAST recognition; noncontrast head CT rapidly; IV thrombolysis within 4.5 h when eligible; mechanical thrombectomy for large-vessel occlusion up to 24 h in selected patients; strict BP thresholds and glucose control.
• Acute Ischemic Stroke — IV Thrombolysis, Endovascular Therapy, and BP Targets

  For eligible patients within 4.5 hours of onset, offer IV thrombolysis. Evaluate for large-vessel occlusion and consider endovascular thrombectomy within 6 hours, and up to 24 hours based on perfusion imaging selection. Maintain BP control (≤185/110 for lysis; permissive hypertension otherwise) and start secondary prevention.
• Acute Ischemic Stroke — Reperfusion Workflow

  Suspected stroke requires rapid imaging, eligibility assessment, and timely IV thrombolytic and or mechanical thrombectomy when indicated; manage blood pressure and glucose and prevent complications.
• Acute Ischemic Stroke — Thrombolysis & Thrombectomy Pathways

  Time‑critical care: IV alteplase within 4.5 hours if eligible; mechanical thrombectomy up to 24 hours in select LVO. Control BP, treat fever/hyperglycemia, start prevention.
• Acute Ischemic Stroke — Thrombolysis, Thrombectomy, and Blood Pressure Targets

  Rapid recognition with last-known-well time is critical. Noncontrast CT excludes hemorrhage; CTA detects large vessel occlusion. Offer IV thrombolysis within established windows when eligible, and consider mechanical thrombectomy up to 24 h in selected LVO cases; manage BP and glucose tightly.
• Aneurysmal Subarachnoid Hemorrhage — Nimodipine, BP Targets, and Early Securing

  Abrupt severe headache with or without focal deficits; CT ± LP for diagnosis. Start nimodipine for vasospasm prophylaxis, manage BP, and secure aneurysm early via coiling or clipping; monitor for hydrocephalus, hyponatremia, and DCI in a neuro‑ICU.

B

• Bacterial Meningitis — Adult

  Medical emergency: give empiric antibiotics and dexamethasone immediately after blood cultures; CT head before LP only if focal deficits, papilledema, seizure, or immunocompromise; tailor therapy to age and risk factors.

C

• Cauda Equina Syndrome — Red Flags and Urgent MRI

  Back pain with saddle anesthesia, urinary retention, and leg weakness is a neurosurgical emergency; obtain emergent MRI and arrange decompression.
• Central Cord Syndrome — Airway, Immobilization, and Timing of Decompression

  Hyperextension injury with hand weakness greater than legs and variable sensory loss; stabilize the spine, optimize hemodynamics, and involve spine surgery to consider early decompression when deficits persist or instability exists.
• Cerebral Venous Sinus Thrombosis — Postpartum Headache, MRI/MRV, and Anticoagulation

  CVST presents with headache, focal deficits, seizures, or papilledema, often postpartum or with prothrombotic states. Diagnose with MRV/CTV and start therapeutic anticoagulation even with venous hemorrhage unless contraindicated.
• Chronic Migraine — Preventive Therapies & CGRP

  Chronic migraine (≥15 headache days/month) benefits from preventives including topiramate, beta‑blockers, tricyclics, onabotulinumtoxinA, and CGRP‑pathway therapies; combine with lifestyle and behavioral strategies.
• Cluster Headache — Acute & Preventive Treatment

  Excruciating unilateral attacks with autonomic signs. Treat acutely with 100% oxygen and subcutaneous sumatriptan; prevent with verapamil plus a transitional steroid taper; avoid triggers during bouts.

E

• Essential Tremor — Diagnosis & Treatment

  Action tremor of hands/head/voice. Treat function‑limiting tremor with propranolol or primidone; combine if needed; consider DBS (VIM) or MR‑guided focused ultrasound for refractory cases.

F

• First Seizure in Adults — ED Evaluation

  Stabilize, check glucose and electrolytes, identify provoking causes, image when indicated, and arrange neurology follow up; start antiseizure drug selectively.
• Functional Neurological Disorder — Recognition & Management

  Diagnose using positive signs (Hoover’s sign, tremor entrainment) — not by exclusion. Early explanation and FND‑informed physiotherapy/CBT improve outcomes; avoid unnecessary repeated investigations.

G

• Guillain‑Barré Syndrome (AIDP) — Respiratory Monitoring, IVIG/PLEX, and Autonomic Care

  Progressive symmetric weakness with areflexia after infection; monitor FVC/NIF for impending respiratory failure. Treat with IVIG or plasma exchange (equivalent efficacy) and manage pain and dysautonomia; avoid steroids.

I

• Idiopathic Intracranial Hypertension — Diagnostic Criteria and Stepwise Therapy

  Obese woman of childbearing age with daily headache and papilledema—consider idiopathic intracranial hypertension (IIH).
• Intracerebral Hemorrhage — Acute Management

  Rapid BP lowering, reversal of anticoagulation, neurosurgical consultation, and ICU-level monitoring; manage ICP and prevent secondary injury.
• Ischemic Stroke — Thrombolysis and Thrombectomy

  Time-critical emergency: evaluate with NIHSS and CT/CTA; give IV thrombolysis within window when eligible; pursue mechanical thrombectomy for large-vessel occlusion per criteria.

L

• Lambert–Eaton Myasthenic Syndrome — Diagnosis & Oncology Links

  Presynaptic NMJ disorder, often paraneoplastic (SCLC). Proximal weakness improves with activity; autonomic symptoms common. Diagnose with VGCC antibodies and incremental EMG; treat cancer, amifampridine, and immunotherapy.

M

• Mild Traumatic Brain Injury — Concussion in Adults

  Identify red flags for imaging, provide early education and graded return to activity, and arrange follow up for persistent symptoms.
• Myasthenic Crisis — Airway Protection, IVIG/Plasma Exchange, and Trigger Control

  Acute worsening of myasthenia gravis with respiratory or bulbar failure. Monitor VC/NIF, prepare for early intubation, hold cholinesterase inhibitors if excessive secretions, and treat with IVIG or plasma exchange; identify triggers (infection, medications). Corticosteroids and immunomodulators follow stabilization.
• Myasthenic Crisis — Airway Strategy, IVIG vs PLEX, and Weaning

  Impending respiratory failure from myasthenia gravis requires ICU-level care; plan early airway strategy, treat with IVIG or plasma exchange, optimize anticholinesterase and immunotherapy, and prevent precipitants while using objective measures to guide extubation.
• Myasthenic Crisis — Airway Strategy, IVIG/Plasma Exchange, and Medication Optimization

  Crisis is respiratory failure from myasthenia gravis. Monitor VC and NIF closely; intubate early if declining. Treat with IVIG or plasma exchange; manage triggers and adjust anticholinesterase and immunosuppressive therapy. Avoid exacerbating drugs (aminoglycosides, fluoroquinolones, magnesium).
• Myasthenic Crisis — Respiratory and Immunotherapy

  Impending or established respiratory failure from myasthenia gravis requires ICU admission, ventilatory support, and early IVIG or plasma exchange.

N

• Neuroleptic Malignant Syndrome — Dopamine Agonists, Dantrolene, and Supportive ICU Care

  Idiosyncratic reaction to dopamine antagonists or withdrawal of dopaminergic drugs. Presents with hyperthermia, rigidity, autonomic instability, and elevated CK. Stop offending agents, provide aggressive supportive care, and consider dantrolene, bromocriptine, or amantadine in moderate–severe cases.
• Neuroleptic Malignant Syndrome — Recognition and Treatment

  Severe reaction to dopamine antagonists with hyperthermia, rigidity, and autonomic instability; stop offending agent, provide ICU supportive care, and consider bromocriptine or dantrolene.

P

• Peripheral Neuropathy — Evaluation & Reversible Causes

  Structured assessment distinguishes patterns and finds reversible causes (diabetes, alcohol, B12, thyroid, medications, toxins, HIV/HCV). Manage cause and neuropathic pain with duloxetine/gabapentinoids; PT and foot care.
• Posterior Reversible Encephalopathy Syndrome (PRES) — Triggers, MRI, and BP/Seizure Control

  Headache, encephalopathy, visual symptoms, and seizures in the setting of acute BP fluctuation, cytotoxic therapy, autoimmune disease, or eclampsia. MRI shows posterior‑predominant vasogenic edema. Treat by removing the trigger, controlled BP reduction, magnesium in eclampsia, and antiepileptics; most cases improve within days to weeks.

R

• Restless Legs Syndrome — Diagnosis & Treatment

  Urge to move legs with unpleasant sensations, worse at rest/night and relieved by movement. Check ferritin and replete iron; use alpha‑2‑delta ligands first‑line; limit dopamine agonists due to augmentation.

S

• Secondary Stroke Prevention — Antiplatelets & Risk Factors

  Prevent recurrence by tailoring antithrombotic therapy to mechanism and controlling vascular risks; short DAPT for minor stroke/TIA; anticoagulate AF‑related strokes; treat BP and LDL aggressively.
• Spontaneous Intracerebral Hemorrhage — BP Targets, Reversal, and ICU Care

  Urgent BP reduction, reversal of anticoagulation, neurosurgical consultation for select cases, and neurocritical monitoring. Consider hematoma expansion risk and spot sign; manage glucose, temperature, and DVT prophylaxis appropriately.
• Spontaneous Intracerebral Hemorrhage — Reversal, BP Control, and Neurosurgical Triage

  Nontraumatic ICH requires rapid BP control (often SBP 140–160), urgent reversal of anticoagulants, and neurocritical care. Identify candidates for neurosurgical intervention (posterior fossa, large lobar with mass effect) and manage ICP/airway; avoid hyperglycemia and fever.
• Status Epilepticus — Adult

  Benzodiazepine first-line (IV lorazepam or IM midazolam); rapidly follow with a second-line antiseizure drug; secure airway and treat causes; escalate to anesthetic infusions for refractory status.
• Status Epilepticus — Adult Management

  Treat seizures lasting ≥5 minutes or recurrent without recovery; benzodiazepines first-line, then second-line antiepileptics; refractory cases require anesthetic infusions and ICU care.
• Status Epilepticus — Benzodiazepine First, Second-Line Antiseizure, and Anesthetic Infusion

  Seizures >5 minutes or recurrent without recovery require protocolized treatment. Give benzodiazepines promptly (IM midazolam or IV lorazepam), followed by a weight-based second-line agent (levetiracetam/valproate/fosphenytoin). Refractory cases require intubation and anesthetic infusions with continuous EEG.
• Status Epilepticus — Benzodiazepines First, Second‑Line ASMs, and Refractory Care

  Seizure activity ≥5 minutes (or recurrent without recovery) warrants immediate benzodiazepines followed by second‑line antiseizure medications (levetiracetam, valproate, or fosphenytoin). Refractory cases require anesthetic infusions and ICU care.
• Status Epilepticus — Benzodiazepines, Second-Line Antiseizure Meds, and Refractory Anesthesia

  Seizure >5 minutes or recurrent seizures without recovery is status epilepticus. Give IM/IV benzodiazepines immediately, then load levetiracetam, fosphenytoin, or valproate. For refractory cases, intubate and start continuous anesthetic infusion with EEG monitoring while treating precipitants.
• Subarachnoid Hemorrhage — Diagnosis & Early Management

  Thunderclap headache is classic; diagnose with CT head and, if needed, LP or CTA; secure aneurysm early; give nimodipine and prevent complications.
• Subarachnoid Hemorrhage — Early ED Management

  Secure ABCs, control pain and blood pressure, prevent rebleeding, treat nausea, and arrange rapid neurosurgical care; consider nimodipine and seizure prophylaxis per local practice.
• Subarachnoid Hemorrhage — Thunderclap Workup

  Severe sudden headache warrants emergent evaluation; noncontrast head CT within 6 hours is highly sensitive; beyond that, CT plus LP or CTA per protocol; control BP and give nimodipine.

T

• Transient Ischemic Attack — ED Workup and Disposition

  Rapid evaluation with vascular imaging and risk stratification; start antiplatelet therapy and high intensity statin when appropriate and arrange expedited follow up or admission.
• Transverse Myelitis — Workup & Acute Treatment

  Acute/subacute inflammatory spinal cord syndrome causing motor, sensory, and autonomic deficits; evaluate urgently and start high‑dose steroids; escalate to plasma exchange if poor response; investigate MS/NMOSD/MOGAD.