NEUROLOGY - STROKE + SEIZURE + HEADACHE

YEAR 3 | PAGE 32B - TIME-CRITICAL NEUROLOGY + NEXT-STEP DECISION MAKING

ACUTE NEUROLOGY IS A SEQUENCE EXAM

The key question is often not “what is the diagnosis?” but “what must happen next?” Stabilize when needed, identify time-sensitive mimics, localize, use the minimum decisive imaging/testing, and do not delay an intervention that is indicated by the current emergency pathway.

C. STROKE - LAST KNOWN WELL -> GLUCOSE -> CT -> VESSEL / REPERFUSION LOGIC

Decision	Reasoning frame	Common trap
Immediate screen	ABCs, exact last-known-well/time discovered, bedside glucose, focused deficit severity and anticoagulant/bleeding context.	Calling it stroke without excluding hypoglycemia or missing time/medication data.
First imaging	Noncontrast head CT to distinguish hemorrhage/mass from ischemia; add vascular/perfusion imaging when it changes thrombectomy or other urgent decisions.	Waiting for MRI before the initial emergency decision.
Reperfusion	Eligibility depends on current guideline windows, imaging, contraindications, BP and deficit/disability. Use live stroke protocol rather than memorized outdated cutoffs.	Treating all ischemic strokes the same or forgetting large-vessel occlusion evaluation.
Hemorrhage / deterioration	Reverse relevant anticoagulation, control physiology per protocol, assess neurosurgical/endovascular need and monitor for edema/herniation.	Applying ischemic-stroke antithrombotic logic to hemorrhage.
Secondary prevention	Mechanism matters: large artery, cardioembolic, small vessel, dissection, hypercoagulable/other.	Choosing prevention before defining likely cause.

D. SEIZURE / STATUS + HEADACHE RED-FLAG LOGIC

Syndrome	High-yield sequence	What separates answers
Seizure / first event	Stabilize -> glucose/metabolic/toxin/pregnancy context -> classify focal vs generalized + awareness -> provoked vs unprovoked -> targeted imaging/EEG as indicated.	A provoked seizure is not the same management problem as recurrent unprovoked epilepsy.
Status epilepticus	Airway/oxygen/glucose -> rapid benzodiazepine -> second-line antiseizure therapy -> refractory-status escalation/continuous monitoring when needed.	Do not wait for EEG or perfect etiology before treating ongoing convulsive status.
Primary headache	Use phenotype: migraine, tension or cluster; ask medication-overuse pattern and treatment contraindications.	Treating a familiar migraine before checking for a changed pattern or red flag.
Secondary headache Ninja Nerd - Acute Ischemic Stroke (~75 min) Ninja Nerd - Seizures + Status Epilepticus (~100 min) Ninja Nerd - Types of Headaches: Primary vs Secondary (~82 min) 2026/27 clerkship-expanded edition - verify school and official exam updates before testing	Thunderclap; fever/meningismus; focal deficit; papilledema; pregnancy/hypercoagulability; cancer/immunosuppression; trauma; new late-onset/progressive pattern.	The “best next test” depends on the suspected dangerous cause, not headache intensity alone.