Neurology

Craniofacial pain

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Last updated: 3/20/2026

Headache in Pregnancy

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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

Neuro-inflammatory

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

Dysautonomia

If you suspect a patient has dysautonomia, workup includes orthostatic blood pressures and laboratory tests of the autonomic nervous system (tilt table test, heart rate variability, QSART, etc.). Often, you can treat the underlying disease. If it is an autoimmune autonomic neuropathy, it may be responsive to IVIG or PLEX.

Last updated: 1/30/2026

Other

NPH

If a patient has hydrocephalus plus the triad of urinary changes, cognitive changes, and gait changes, suspect NPH. NPH diagnosis is based on clinical symptoms as well as transient improvement of symptoms after CSF drainage. Shunt surgery is the only established treatment for NPH. Before doing so, though, rule out reversible causes of these symptoms.

Last updated: 1/30/2026

Other

Tremor

Tremor has many different causes. If it is a primary tremor, you do not have to treat it unless it is functionally limiting or embarrassing for the patient. If it is a secondary tremor, you can treat the underlying cause.

Last updated: 1/30/2026

Parkinsonism Features

Established Parkinsons

Parkinsons is a neurodegenerative disorder with tremor, rigidity, and bradykinesia. It is a clinical diagnosis, but DAT scans can be helpful. Treatment is with dopaminergic agents.

Last updated: 1/30/2026

Parkinsonism Features

Parkinsonism includes features like rigidity, hypomimia, resting tremor, and difficulties with gait. The differential is broad.

Last updated: 1/30/2026

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

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: 3/20/2026

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 (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

Myelitis

Myelitis is inflammation of the spinal cord. 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

Post-Operative Assessment in a Patient with Myasthenia Gravis

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: 3/27/2026