Neurology

Cerebrovascular Diseases

6

Overview of Cerebrovascular Anatomy & Blood Supply

(Circle of Willis, anterior vs. posterior circulation, vascular localizations, homunculus)

Transient Ischemic Attack (TIA)

(ABCD2 score, carotid Doppler screening, secondary prevention, dual antiplatelet therapy)

Acute Ischemic Stroke

(tPA treatment window, mechanical thrombectomy, non-contrast CT, permissive hypertension, penumbra)

Intracerebral Hemorrhage

(Basal ganglia, Charcot-Bouchard microaneurysms, hypertensive vasculopathy, amyloid angiopathy, strict blood pressure control)

Subarachnoid Hemorrhage

(Berry aneurysms, thunderclap headache, xanthochromia, nimodipine, vasospasm prevention)

Cerebral Venous Thrombosis

(Hypercoagulable states, empty delta sign, MR venography, anticoagulation with heparin)

Seizure Disorders & Epilepsy

4

Approach to the First Seizure

(EEG indications, prolactin elevation, structural MRI, provoking factors, alcohol withdrawal)

Focal Seizures

(Retained vs. impaired awareness, temporal lobe epilepsy, focal auras, carbamazepine, postictal Todd paralysis)

Generalized Seizures

(Absence, tonic-clonic, myoclonic, valproate, ethosuximide, 3-Hz spike-and-wave discharges)

Status Epilepticus

(Medical emergency, abortive IV lorazepam, continuous EEG, fosphenytoin loading, airway management)

Headaches & Facial Pain Syndromes

5

Migraine Headaches

(Unilateral, pulsating, aura, photophobia, triptans, CGRP antagonists, abortive vs. prophylactic therapy)

Tension-Type Headaches

(Bilateral, band-like, non-throbbing, physical stress triggers, NSAIDs, amitriptyline)

Cluster Headaches

(Unilateral, severe periorbital pain, lacrimation, Horner syndrome, 100% oxygen, verapamil prophylaxis)

Trigeminal Neuralgia

(Lancinating facial pain, V2/V3 distribution, trigger zones, chewing pain, carbamazepine)

Idiopathic Intracranial Hypertension

(Pseudotumor cerebri, papilledema, young obese females, visual field loss, acetazolamide, therapeutic lumbar puncture)

Neurocognitive & Dementing Disorders

6

Mild Cognitive Impairment vs. Normal Aging

(Preserved activities of daily living, MoCA testing, non-pathological memory slips)

Alzheimer Disease

(Amyloid beta plaques, tau neurofibrillary tangles, insidious memory loss, donepezil, memantine)

Vascular Dementia

(Step-wise cognitive decline, executive dysfunction, underlying white matter lesions, cardiovascular risk factors)

Frontotemporal Dementia

(Pick disease, prominent behavioral changes, early disinhibition, expressive aphasia, early onset)

Lewy Body Dementia

(Visual hallucinations, parkinsonism, fluctuating cognition, REM sleep behavior disorder)

Normal Pressure Hydrocephalus

(Classic triad of wet, wobbly, and wacky; magnetic gait, large ventricles, large volume therapeutic tap, VP shunt)

Movement Disorders

5

Parkinson Disease

(Resting pill-rolling tremor, bradykinesia, cogwheel rigidity, levodopa/carbidopa, substantia nigra pars compacta)

Essential Tremor

(Action tremor, familial history, temporary improvement with alcohol, propranolol, primidone)

Huntington Disease

(CAG trinucleotide repeat, chorea, caudate nucleus atrophy, early psychiatric symptoms, tetrabenazine)

Parkinson-Plus Syndromes

(Multiple system atrophy, progressive supranuclear palsy, vertical gaze palsy, severe autonomic failure)

Restless Legs Syndrome

(Irresistible urge to move legs, iron deficiency anemia screening, dopamine agonists, gabapentin)

Demyelinating, Motor Neuron & Spinal Cord Diseases

5

Multiple Sclerosis

(Relapsing-remitting, optic neuritis, internuclear ophthalmoplegia, oligoclonal bands, Dawson fingers, interferon beta, natalizumab)

Amyotrophic Lateral Sclerosis

(Upper and lower motor neuron signs, preserved sensation, fasciculations, bulbar weakness, riluzole)

Transverse Myelitis

(Post-infectious spinal cord inflammation, distinct sensory level, bowel/bladder dysfunction, high-dose IV steroids)

Syringomyelia

(Cape-like distribution of pain/temperature loss, anterior white commissure, Chiari malformation association)

Subacute Combined Degeneration

(Vitamin B12 deficiency, dorsal column loss, lateral corticospinal tract involvement, megaloblastic anemia)

Peripheral Neuropathies & Neuromuscular Disorders

5

Guillain-Barré Syndrome

(Ascending flaccid paralysis, absent reflexes, Campylobacter jejuni, albuminocytologic dissociation, IVIG or plasmapheresis)

Myasthenia Gravis

(Fatigable weakness, ptosis, diplopia, ACh receptor antibodies, thymoma, pyridostigmine, ice pack test)

Lambert-Eaton Myasthenic Syndrome

(Proximal weakness that improves with muscle use, voltage-gated calcium channels, paraneoplastic small cell lung cancer)

Peripheral & Diabetic Neuropathies

(Stocking-glove distribution, impaired vibration/proprioception, gabapentin, SNRI therapy, foot care)

Idiopathic Inflammatory Myopathies

(Polymyositis, dermatomyositis, symmetrical proximal muscle weakness, elevated CK, Gottron papules, anti-Jo-1 antibodies)

Central Nervous System Infections

5

Bacterial Meningitis

(Streptococcus pneumoniae, Neisseria meningitidis, nuchal rigidity, empiric ceftriaxone + vancomycin, dexamethasone timing)

Aseptic Meningitis

(Enterovirus, self-limiting, normal glucose, CSF lymphocytosis, supportive care)

Herpes Simplex Encephalitis

(HSV-1, altered mental status, focal temporal lobe edema, CSF PCR, emergent IV acyclovir)

Brain Abscess

(Ring-enhancing lesion, focal neurologic deficits, contiguous vs. hematogenous spread, toxoplasmosis in HIV, stereotactic aspiration)

Neurosyphilis

(Tabes dorsalis, Argyll Robertson pupil, positive CSF VDRL, high-dose aqueous penicillin G)

Neuro-Emergencies, Trauma & Toxicometabolic Disorders

4

Elevated Intracranial Pressure & Herniation Syndromes

(Cushing triad, uncal herniation, blown pupil/CN III palsy, hyperventilation, mannitol)

Epidural & Subdural Hematomas

(Middle meningeal artery vs. bridging veins, lucid interval, crescent-shaped vs. biconvex, surgical evacuation criteria)

Epidural Spinal Cord Compression

(Known malignancy history, progressive thoracic back pain, late hyperreflexia, emergent IV dexamethasone, stat spine MRI)

Wernicke Encephalopathy & Korsakoff Syndrome

(Thiamine deficiency, triad of ophthalmoplegia, ataxia, and confusion; confabulation, mammillary body atrophy)