EM Boards Survival Guide: Neurology 1

Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit)

Welcome back to the EM Boards Survival Guide! This emDocs series will provide you with regular tips and must-know items for EM boards and inservice. Each post will feature several key takeaways on a specific organ system. This week we cover neurology.

Boards Must-Knows:

1) Bell’s palsy: Must differentiate from stroke (closely evaluate for other neurologic deficits and forehead sparing). HSV (#1). Bilateral: consider Lyme, HIV. Treatment: steroid +/- antiviral + eye patch.

2) Benign headache: Tension (#1). Migraine w/out aura (MC for migraines). Cluster: know classic presentation and how to treat.

3) Dystonic reaction: Know patient presentation and common etiologies (antidopaminergic meds). Rx: diphenhydramine or benztropine.

4) Encephalitis: Febrile, young patient + behavioral change +/- seizure. HSV: temporal lobes; start acyclovir. Know anti-NDMA receptor encephalitis.

5) Guillain-Barre: Ascending motor paralysis + loss of reflexes s/p infectious trigger. Watch for airway involvement. Rx: IVIG, plasmapheresis.

6) Ischemic stroke: Know myriad of presentations and guidelines for imaging/treatment. Permissive HTN. Know major contraindications of tPA. What reduces mortality? Admission to stroke floor.

7) Meningitis: Know most common bugs for different age groups / risk factors. Strep pneumo (#1 overall). Rx: vancomycin + ceftriaxone +/- ampicillin (Listeria) +/- acyclovir (HSV).

8) Multiple sclerosis: 1stpresentation commonly optic neuritis. Patients complaint typically doesn’t fit traditional neuro pattern. Diagnosis: need MRI; LP with IgG oligoclonal bands. Rx: steroids for flare; look for infectious trigger.

9) Myasthenia gravis: Descending weakness. Abs against ACh receptors at NM junction. Improves w/ rest, cold. Know meds to avoid. Rx: anticholinesterase, except in crisis => watch airway, Neuro for IVIG/plasmapheresis/steroid.

10) Normal Pressure Hydrocephalus: memory / urinary / gait issues (“wacky / wet / wobbly”). Consider this in the ‘ new dementia’ presentation. Normal opening pressure on LP + large ventricles on CT brain.

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