Neuro rapid review: the brain starved, irritated, or disconnected

ISCHEMIC STROKE. A clot stops flow in one vascular territory and the tissue downstream begins to die. Exam hook: the deficit names the vessel. Anterior cerebral gives contralateral leg weakness with incontinence and flat affect. Middle cerebral gives contralateral face and arm weakness, with aphasia when the dominant hemisphere is involved and neglect when it is not. Posterior cerebral gives homonymous visual field loss. Posterior circulation gives vertigo, dysarthria, dysphagia, ataxia, and double vision.

HEMORRHAGIC STROKE. Bleeding raises pressure and irritates tissue. Sudden worst headache of the patient's life, vomiting, and rapid decline in consciousness. Exam hook: no thrombolytic, ever.

THE CLOCK AND THE GATE. Intravenous thrombolysis is offered inside a window measured from the time the patient was last known well, not from the time symptoms were noticed. The standard window is 3 hours, extended to 4.5 hours for selected patients. The gate is three assessments: a noncontrast head computed tomography scan excluding hemorrhage, a stroke severity score, and a bedside glucose, because hypoglycemia mimics stroke and is reversible in minutes. Blood pressure must be brought below 185/110 mm Hg before the drug is given and held below 180/105 mm Hg for the 24 hours after. Re-verify these thresholds against the current AHA/ASA acute ischemic stroke guideline, because they have moved.

SEIZURE. Protect, position, and time it. Side-lying, nothing forced into the mouth, no restraint of the limbs, suction and oxygen ready. Exam hook: the correct action is never to stop the movement.

STATUS EPILEPTICUS. Continuous seizure activity past 5 minutes, or repeated seizures without recovery in between. A benzodiazepine is first line, a second-line antiseizure agent follows → BOOK 05 · P14.

MENINGITIS. Fever, headache, nuchal rigidity, photophobia, altered mental status. Droplet precautions are instituted for suspected meningococcal disease and maintained through the first 24 hours of effective therapy → BOOK 04 · P7. Exam hook: antibiotics are not delayed for the lumbar puncture.

MYASTHENIC VERSUS CHOLINERGIC CRISIS. Both present as weakness with failing respiration. Undermedication produces the myasthenic form. Overmedication with a cholinesterase inhibitor produces the cholinergic form, with pinpoint pupils, drooling, sweating, cramping, diarrhea, and fasciculations. Exam hook: the secretions decide it.

GUILLAIN-BARRÉ. Symmetric weakness ascending from the feet with lost deep tendon reflexes, often two to four weeks after a gastrointestinal or respiratory infection. Exam hook: serial vital capacity is the assessment that matters, not strength testing.

Margin notelast known well, not last seen normal-ish. Ventilatory failure is → BOOK 09 · P6.

Takeawayterritory explains the deficit, and in every neuromuscular emergency on this page the airway is assessed before the weakness is.