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🧠 Neurological System Clinical Cheat Sheet
⚡ SEIZURES & EPILEPSY
Definition: Uncontrolled neuronal discharges → abnormal brain activity. Pathophysiology: ↓ O ₂ → acidosis → electrolyte imbalance → seizure; ↑ O ₂use during seizure → hypoxemia + lactic acidosis. Key Point: Seizure ≠ epilepsy — epilepsy = recurrent, unprovoked seizures. Epilepsy Diagnostic Criteria (ILAE, 2022): ≥2 unprovoked seizures >24 hrs apart 1 unprovoked seizure + ≥60% recurrence risk Diagnosis of seizure syndrome Types: Type Description Focal (Partial) (^) Localized area of brain Simple partial Consciousness intact, twitching, sensory symptoms Complex partial Altered consciousness, repetitive actions Generalized Both hemispheres involved Absence Brief staring (children) Tonic Muscle stiffening Clonic Rhythmic jerking Tonic-clonic Stiffening + jerking + LOC Atonic Sudden loss of tone Myoclonic Sudden brief jerks Phases: Prodrome → Aura → Ictus → Postictal (confusion, fatigue, soreness) Diagnostics: EEG (brain waves), MRI/CT, electrolytes, glucose, toxins, infection screen Management: AEDs (e.g., carbamazepine, valproate), ketogenic diet, VNS/RNS devices, surgery if focal lesion Education: Medication adherence, trigger avoidance, no driving until cleared
🧠 PSYCHOGENIC NONEPILEPTIC EPISODES (PNES)
Definition: Seizure-like episodes without abnormal brain activity — psychological origin. Clues: Unequal movements, eyes closed, speech during episode, no postictal confusion. Diagnosis: Video EEG (gold standard) + mental health evaluation. Treatment: Psychological therapy, stress management, empathy & validation essential.
🧠 HEADACHES
Primary: Origin in cranial vessels/nerves/muscles. Secondary: Due to underlying disease (tumor, infection, HTN, bleed, etc.) Type Key Features Treatment Tension “Band-like” tightness; bilateral; due to muscle strain, stress NSAIDs, relaxation, PT Migraine Unilateral throbbing pain, photophobia, N/V; with or without aura Triptans, antiemetics, rest, trigger avoidance Cluster Severe unilateral orbital pain, tearing, nasal congestion; cyclic O ₂therapy, triptans Migraine Phases: Prodrome → Aura → Headache → Postdrome Triggers: Stress, sleep disruption, hormones, caffeine, lights, MSG, strong odors.
⚙️ CRANIAL NERVE DISORDERS
🧠 Trigeminal Neuralgia (CN V) Pain: Sudden, electric shock–like unilateral facial pain (seconds–minutes). Triggers: Chewing, touch, wind, speaking. Diagnostics: MRI (rule out compression or MS). Treatment: Meds: Carbamazepine (1st-line), gabapentin, baclofen Procedures: Microvascular decompression, gamma knife, rhizotomy Support: CBT, relaxation, PT, avoid triggers 🧠 Bell’s Palsy (CN VII)
