Neurology
Cognitive
AMS Without Active Cancer
REMEMBER: AMS with brain stem abnormalities is a basilar artery occlusion until proven otherwise. You will need a stat CTH and CTA brain/neck.
Last updated: 1/30/2026
Chronic Dementia
The approach to chronic dementia is to first obtain examples of the deficits to understand which of the 6 cognitive domains it affects. Then, understand how it affects the patient’s life (morbidity) and the workup that has been done so far. Finally, with this information, you can ask more directed questions to assess for an underlying disorder.
Last updated: 2/9/2026
Established Dementia
The approach to established dementia is to maintain the patient's functional status, treat reversible causes of memory impairment, and avoid polypharmacy. Support for caregivers is also important as dementia can be more distressing for caregivers than the patient themselves.
Last updated: 1/30/2026
Rapidly Progressing Dementia
Rapidly progressive dementia can be due to many causes, some of which are life threatening. In particular, rapidly progressive dementia with myoclonus should make you think CJD.
Last updated: 1/30/2026
Headache
Established Migraine with Acute Worsening
When approaching a patient with a known history of migraine headache who experiences recent headache worsening, evaluate for recent medication changes and lifestyle factors and determine whether there is a change in headache characteristics or pattern that warrants additional work-up.
Last updated: 3/27/2026
Craniofacial pain
Blurb needed
Last updated: 3/20/2026
Headache in Pregnancy
Blurb needed
Last updated: 3/20/2026
Idiopathic Intracranial Hypertension
IIH is a disorder related to increased intracranial pressure of unknown cause, primarily affecting women of childbearing age (20–50) with a body max index >30.
Last updated: 3/27/2026
New Onset Headache
The majority of individuals presenting with a new headache will likely be diagnosed with a benign headache, however, in a minority a potentially serious etiology may be identified. A systematic approach to headache history and knowledge of the signs and symptoms suggestive of a secondary cause for headache is essential.
Last updated: 3/27/2026
PRES
PRES stands for 'Posterior Reversible Encephalopathy Syndrome,' although MRI findings are not always posterior, and the symptoms are not always reversible. It is often triggered by sudden rise in BP. Timing and symptoms can help you determine your level of suspicion for PRES. If high, MRI is more sensitive than CT.
Last updated: 1/30/2026
Neuro-inflammatory
MS Relapse
MS is a demyelinating disease process. An MS relapse will have corresponding enhancing lesions on MRI. A pseudo-relapse will not show any new lesions on MRI. If it is a pseudo-relapse, treat the underlying cause (e.g. infection). If it is an MS relapse, treat with steroids, and if severe, IVIG/PLEX. Other demylinating diseases to keep on your differential are NMO, MOG, CNS Sjogren's, and toxic, inflammatory and metabolic disorders.
Last updated: 3/27/2026
Optic Neuritis
Inflammation of the optic nerve is a commonly associated with multiple sclerosis (as a presenting symptom or during the course of the disease), however, many other conditions may cause optic nerve dysfunction which can often be elicited through a comprehensive history.
Last updated: 3/27/2026
Other
Parkinsonism Features
Seizure/Syncope/Dizziness
Acute Onset Dizziness
Utilizing a timing and triggers approach to acute onset dizziness often identifies an underlying etiology for the patient’s presentation.
Last updated: 3/27/2026
First Time Seizure
The approach to a first time seizure is to first obtain a thorough description of the episode. This will help you differentiate a nonepileptic seizure from an epileptic one. Then, assess for possible triggers for the episode and whether the patient has had any unrecognized seizures in the past. After a first time seizure, an EEG and MRI seizure protocol should be performed to assess the patient’s risk for a recurrent seizure. If these are normal, the chance for a second seizure is ~30% and AEDs are typically not recommended.
Last updated: 3/20/2026
Known Epilepsy with Breakthrough Seizure
The approach to a breakthrough seizure is to first characterize the episode and determine what the precipitating factor was. This will help guide treatment. If it is due to medication non-compliance, patients are restarted on their home meds +/- a loading dose.
Last updated: 3/20/2026
Orthostatic Hypotension/Autonomic Dysfunction
Orthostatic hypotension (OH) is defined as a fall in blood pressure (>20 mm Hg fall in systolic BP OR >10 mm Hg fall in diastolic BP) that occurs within three minutes of standing up from a lying or seated position. Through history taking and vitals assessment, OH should be classified as neurogenic and/or non-neurogenic, with specific etiologies identified. Neurogenic orthostatic hypotension is caused by dysfunction of the baroreceptor reflex. Non-neurogenic causes for orthostatic hypotension are more common and are a result of external reversible factors that impair normal hemodynamic compensation.
Last updated: 5/24/2026
Seizure vs Syncope
It can be difficult to differentiate seizures from syncope, but directed questions involving the semiology of the episode and associated symptoms can help differentiate the two.
Last updated: 3/20/2026
Status Epilepticus
This is a neurologic emergency. If generalized convulsive, treat aggressively with benzos and 2nd line agents. If seizures persist, will need neuro ICU admission. They will also need cEEG, CTH, and CTA brain/neck as stroke can rarely present as status. If they are also febrile or immunocompromised, start broad spectrum CNS abx and have a low threshold for an LP. If pt is in focal status, use can just use benzos and obtain cEEG.
Last updated: 5/24/2026
Weakness
Facial Weakness
The approach to facial weakness is to first determine if it is an upper motor neuron lesion (spares forehead) or a lower motor lesion (involves forehead). An upper motor neuron lesion suggests the lesion is above the brainstem while a lower motor neuron involves the facial nucleus or the nerve itself.
Last updated: 1/30/2026
Myasthenia Gravis (Post-Operative Assessment)
Worsening of symptoms of myasthenia gravis Is a known potential complication following surgery. History should focus on understanding baseline deficits (if present) and identifying new or worsening post-op deficits, in conjunction with the neurologic exam and ancillary studies such as respiratory parameters.
Last updated: 5/24/2026
Myasthenia Gravis (suspected diagnosis or established diagnosis)
Myasthenia gravis is a chronic autoimmune neuromuscular disorder with a bimodal age distribution classified as early onset (age 20s-30s, women > men and late-onset (age 60s-80s men > female). Symptoms may seem relatively non-specific. A history of fatiguing/fluctuating weakness involving preferentially affected muscle groups adds to diagnostic certainty.
Last updated: 3/22/2026
Rapidly Progressing Weakness
If a patient has acute onset upper and/or lower extremity weakness (7 days or less), do not miss structural cord compression as this is a neurologic emergency. Obtain STAT MRI of the entire spine without contrast. If there is a history of cancer, obtain the MRI with and without contrast to evaluate for epidural mets. If weakness is hyperacute, get MRI with DWI to assess for spinal cord ischemia. If weakness is <48h, also get CTH and CTA head/neck to rule out basilar artery occlusion. If they are diffusely areflexic/hyporeflexic, also do an LP to evaluate for AIDP. You will also need to order telemetry, NIF/FVC q4h, and start IVIG ideally after serum studies collected unless contraindications.
Last updated: 1/30/2026