Neurology

Disease Clinical features Diagnosis Management

Epilepsy Partial seizures 1st line 2nd line
EEG Partial seizures
Partial seizures CT scan Carbamazepine phenytoin
Simple partial MRI 400- 1600 mg 200-400 mg
Complex partial Lamotrigine phenobarbital
Partial seizure with Complex seizures 100-300 mg
secondary Tonic-clonic Sodium valproate gabapentin
generalization EEG 500-2500 mg 900-3600 mg
10Hz activity during
Complex seizure tonic phase Tonic - clonic seizures
Atonic Slow waves during Sodium valproate carbamazepine
Tonic clonic phase Lamotrigine phenytoin
Clonic Topiramate
tonic - clonic Absence seizures
Myoclonic EEG Absence seizure lamotrigine
Absence 3 spikes and waves Ethosuximide
per second 500-1500 mg
Sodium valproate

Myoclonic seizure piracetam

Sodium valproate
Clonazepam

Epilepsy Repeated seizures Semi prone position to decrease risk of

Prolonged tonic clonic aspiration
Status epilepticus seizure Check airway
Give normal saline IV

Thiamine 100 mg IV
Dextrose 50 g IV
Diazepam 10 mg IV
Repeat once after 15 min

Seizure continue after 30 min

Phenytoin 1g IV
Fosphenytoin 1g IV

Seizure continue after 60 min

Endotracheal intubation
EEG
ICU admission
Phenobarbital 1g IV
 Seizures continue
General anesthesia
Propofol

Seizure controlled
Detect cause
Anticonvulsant therapy

Migraine Throbbing headache Avoid triggers

Moderate to severe
Common migraine pain Aspirin
( without aura ) 4hr-72 hr Paracetamol
Headache (bilateral) Physical activity NSAIDs
Nausea aggravates it
Vomiting Received by sleep , Triptants
Classical migraine darkness Sumatriptan
(with aura ) Nausea Tryptin + NSAIDs
Headache(unilateral Vomiting
Nausea Photophobia Beta blockers
Vomiting Phonophobia Calcium channel blockers
Visual aura Sodium valproate

Trigeminal neuralgia Severe pain Carbamazepine DOC

Repetitive pain Gabapentin
Knife like pain in face Alcohol injection in branches
Surgical decompression of nerve
Triggered by
Touching face
Cold wind blow on face
Eating
Speaking

Meningitis Acute pyogenic Blood culture Ceftriaxone 2g IV + vancomycin 15 mg /kg IV

meningitis Lumbar puncture Steroids
Fever CT scan Dexamethasone
Headache Antipyretics
Neck stiffness
Photophobia
Nausea
Vomiting
Seizures
Altered consciousness
Nuchal rigidity

Tuberculosis
meningitis Antituberculous therapy
Headache Steroids
 Fever
Vomiting
Depression
Confusion
Oculomotor palsy

Bell's palsy Unilateral weakness of Prednisolone 40 -60 mg for 1 week

half face
Mouth droop on
paralyzed side
Flat nasolabial fold
Cannot wrinkle
forehead
Eye doesn't close
Taste dysfunction
Hearing dysfunction
Increased tearing
Atrophy of facial
muscles

Parkinson's disease Resting tremors Carbidopa - levodopa

4- 6 Hz frequency OR
Pill rolling Dopamine agonists → ropinirole
OR
Postural tremors Monoamine oxidase inhibitors → rasagiline
8-10 Hz
COMT inhibitors → tolcapone
Rigidity Anticholinergics → benztropine
Cogwheel rigidity
Plastic rigidity Surgery
Deep brain stimulation of thalamus
Bradykinesia
Festinating gait
Postural instability
Reduced arm swing
Impaired turning
Expressionless face
Small handwriting

Stroke TIA
Unilateral weakness
Transient ischemic Speech impairment
attack TIA Less than 1 hour
Ischemic stroke
Hemorrhagic stroke
Ischemic stroke Anterior Cerebral CT scan Tissue plasminogen activator TPA IV
artery ischemia MRI Heparin
Contralateral weakness CT angiography Aspirin 300 mg
Sensory loss in legs MRA
Confusion Ultrasound of carotids Surgery
Urinary incontinence ECG Carotid endarterectomy
Spared face Echocardiogram
CBC Secondary prevention
Middle cerebral artery ESR BP control
ischemia Diabetes control
Contralateral weakness Lipid control
Sensory loss in face Smoking cessation
Visual defect Lower salt intake
Lower fat intake
Posterior cerebral Weight loss
artery ischemia Lower sugar intake
Visual defect Increase exercise
Hallucinations
Visual agnosia

Vertebrobasilar
arteries
(posterior circulation
)

Vertebral artery
Sensory loss of
ipsilateral face
Sensory loss of
contralateral limbs
Diplopia

Basilar artery
Sensory loss
Cranial nerve paralysis
Aware but no response

Cerebellar artery
Vertigo
Nausea
Vomiting
Diplopia
Nystagmus

Hemorrhagic stroke Intraparenchymal CT scan Airway maintenance

hemorrhage MRI Avoid hyperthermia
Intraparenchymal Altered consciousness Angiography Head elevated
hemorrhage Headache BP control
Subarachnoid Vomiting Anticonvulsants
hemorrhage Seizures Surgical decompression of artery
Subarachnoid CT scan BP control
hemorrhage MRI Calcium channel blockers 30 mg
Fast onset Anticonvulsants
Painful Surgical clipping of aneurysm
Thunderclap headache Platinum coil insertion in aneurysm
Loss of consciousness
Vomiting
Neck stiffness
Photophobia