30 types nervous system disease treatment investigation finding differential diagnosis contraindication ICO management OPD prescription prognosis and diet and nutrition
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Given the scope of this request (30 diseases × 10+ clinical dimensions each), and the budget constraints, I'll compile a comprehensive reference from my medical knowledge base synthesized with textbook principles. This is the most complete and practical approach within the available budget.
30 Nervous System Diseases — Complete Clinical Reference
Structured for each disease: Types · Treatment · Investigation · Findings · Differential Diagnosis · Contraindications · ICU Management · OPD Prescription · Prognosis · Diet & Nutrition
1. ISCHEMIC STROKE
| Domain | Details |
|---|---|
| Types | Thrombotic (large vessel, lacunar), Embolic (cardioembolic, artery-to-artery), Cryptogenic |
| Investigations | Non-contrast CT head (immediate), MRI DWI (gold standard), CT angiography, ECG, Echo, CBC, coagulation profile, lipid profile, HbA1c, fasting glucose |
| Findings | MRI DWI: restricted diffusion; CT: hypodense area after 24h; NIHSS score; carotid Doppler stenosis |
| Differential Dx | Hemorrhagic stroke, Todd's paralysis post-seizure, hypoglycemia, brain tumor, MS, hypertensive encephalopathy |
| Treatment | IV tPA (alteplase) within 4.5 hrs if no contraindications; mechanical thrombectomy within 24 hrs for large vessel occlusion; aspirin 325 mg within 24–48 hrs |
| Contraindications | tPA contraindicated in: BP >185/110 not controlled, active bleeding, recent surgery <14 days, INR >1.7, platelet <100,000, prior hemorrhagic stroke |
| ICU Management | Airway protection if GCS ≤8; BP target 185/110 pre-tPA, <180/105 post-tPA; glucose 140–180; avoid hyperthermia; ICP monitoring if needed; DVT prophylaxis |
| OPD Prescription | Aspirin 75–100 mg OD OR clopidogrel 75 mg OD; atorvastatin 40–80 mg; antihypertensive (amlodipine/ramipril); anticoagulation if AF (warfarin/DOAC) |
| Prognosis | 30-day mortality ~15%; 1-year independence ~55–60%; full recovery uncommon with large infarcts |
| Diet & Nutrition | Low sodium (<2 g/day), Mediterranean diet, low saturated fat, adequate hydration; dysphagia assessment before oral feeding |
2. HEMORRHAGIC STROKE (Intracerebral Hemorrhage)
| Domain | Details |
|---|---|
| Types | Primary (hypertensive, amyloid angiopathy), Secondary (AVM, tumor, coagulopathy) |
| Investigations | CT head (gold standard — hyperdense area), MRI, CTA/MRA, coagulation studies, CBC, toxicology screen |
| Findings | CT: hyperdense lesion; mass effect; midline shift; perilesional edema; spot sign on CTA predicts expansion |
| Differential Dx | Ischemic stroke, subdural hematoma, epidural hematoma, brain abscess, tumor bleed |
| Treatment | Reverse anticoagulation urgently (vitamin K, FFP, PCC, protamine); BP target <140 mmHg systolic; surgical evacuation if cerebellar >3 cm or deteriorating |
| Contraindications | Thrombolytics, anticoagulants, NSAIDs; aggressive BP lowering <130 systolic acutely harmful |
| ICU Management | Head elevation 30°; ICP monitoring; avoid hypotension; correct coagulopathy; seizure prophylaxis if lobar; mannitol/hypertonic saline for raised ICP |
| OPD Prescription | Control BP (target <130/80); treat underlying cause; restart anticoagulation after 4–8 weeks if indication present |
| Prognosis | 30-day mortality 35–40%; ICH score guides prognosis; survivors often have significant disability |
| Diet & Nutrition | DASH diet; low sodium; avoid alcohol; vitamin K consistency if on warfarin |
3. SUBARACHNOID HEMORRHAGE (SAH)
| Domain | Details |
|---|---|
| Types | Aneurysmal (85%), non-aneurysmal perimesencephalic (10%), other (AVM, trauma) |
| Investigations | CT head (first line), LP if CT negative (xanthochromia), CTA/MRA/DSA (aneurysm detection) |
| Findings | CT: hyperdense cisterns; xanthochromia on LP; Hunt and Hess grade; Fisher grade |
| Differential Dx | Meningitis, thunderclap migraine, CVT, hypertensive crisis, cervical artery dissection |
| Treatment | Nimodipine 60 mg q4h for 21 days (vasospasm prevention); aneurysm: coiling (preferred) or clipping; analgesics (codeine); anti-emetics |
| Contraindications | NSAIDs (bleeding risk); hypotension; anticoagulation before aneurysm secured |
| ICU Management | Strict bed rest; nimodipine IV if oral not tolerated; euvolemia; avoid hyponatremia; BP management; transcranial Doppler for vasospasm |
| OPD Prescription | Nimodipine; antihypertensives; statins; anti-epileptics if seizure occurred |
| Prognosis | 30-day mortality ~40%; re-bleed risk highest within first 24 hrs; 50% of survivors have neuropsychological deficits |
| Diet & Nutrition | Oral intake after swallowing assessment; high protein for recovery; low sodium; avoid caffeine/alcohol |
4. EPILEPSY
| Domain | Details |
|---|---|
| Types | Focal (aware/impaired), Generalized (tonic-clonic, absence, myoclonic, atonic), Unknown onset; Syndromes: JME, childhood absence, LGS |
| Investigations | EEG (interictal/ictal), MRI brain (3T protocol), CBC, electrolytes, glucose, drug levels, LFT, RFT |
| Findings | EEG: spike-wave discharges; MRI: hippocampal sclerosis, cortical dysplasia; ictal semiology |
| Differential Dx | Syncope, TIA, NEAD (non-epileptic attack disorder), migraine with aura, hypoglycemia, narcolepsy |
| Treatment | Focal: levetiracetam, lamotrigine, carbamazepine; Generalized: valproate (males/non-childbearing females), lamotrigine, levetiracetam; surgery if drug-resistant |
| Contraindications | Carbamazepine in generalized epilepsy; valproate in women of childbearing age; phenytoin in absence epilepsy |
| ICU Management | Status epilepticus protocol: benzodiazepine → levetiracetam/valproate → phenobarbital → propofol/midazolam infusion → ketamine; ABG, glucose, EEG monitoring |
| OPD Prescription | Levetiracetam 500–1500 mg BD; or lamotrigine 25–200 mg BD; or carbamazepine 200–400 mg BD; folic acid supplementation |
| Prognosis | 70% achieve seizure freedom with medication; drug-resistant epilepsy in ~30%; surgery successful in 60–70% of selected cases |
| Diet & Nutrition | Ketogenic diet (4:1 fat:carb) in drug-resistant epilepsy especially children; maintain regular meals; avoid alcohol |
5. MENINGITIS (Bacterial)
| Domain | Details |
|---|---|
| Types | Bacterial (S. pneumoniae, N. meningitidis, L. monocytogenes), Viral (enterovirus, HSV), Fungal (Cryptococcus), TB |
| Investigations | LP: CSF (opening pressure, cell count, glucose, protein, culture, gram stain, PCR); blood cultures; CT head before LP if focal signs; CBC, CRP, PCT |
| Findings | CSF: turbid, high PMN (bacterial), lymphocytic (viral/TB), low glucose (<45 or CSF:serum <0.4 bacterial), high protein; blood cultures positive in 50% |
| Differential Dx | Viral meningitis, SAH (thunderclap headache), brain abscess, encephalitis, fungal meningitis |
| Treatment | Empirical: ceftriaxone 2 g IV q12h + dexamethasone 0.15 mg/kg q6h × 4 days + acyclovir until HSV excluded; add ampicillin if age >50/immunosuppressed (Listeria) |
| Contraindications | LP contraindicated if papilledema, focal neurological deficit, GCS <13, coagulopathy before CT and stabilization |
| ICU Management | Airway protection; ICP management; seizure treatment; fluid balance; frequent neuro-obs; steroids reduce mortality and deafness |
| OPD Prescription | Complete antibiotic course; rifampicin prophylaxis for close contacts (meningococcal); vaccination (meningococcal, pneumococcal) |
| Prognosis | Mortality: pneumococcal 20–30%, meningococcal 10%; deafness, cognitive impairment in survivors |
| Diet & Nutrition | NG feeding if unable to eat; high calorie/protein; oral rehabilitation post-discharge |
6. ENCEPHALITIS
| Domain | Details |
|---|---|
| Types | Viral (HSV-1 most common, EBV, CMV, enterovirus), Autoimmune (anti-NMDA receptor, LGI1, CASPR2), Bacterial/parasitic |
| Investigations | MRI brain (temporal lobe signal in HSV), EEG (temporal PLEDs in HSV), LP (CSF PCR for HSV, enterovirus), autoimmune antibody panel, CBC, LFT |
| Findings | HSV: MRI T2 hyperintensity in temporal/frontal lobes; anti-NMDA: normal MRI, CSF lymphocytosis; EEG: slowing, PLEDs |
| Differential Dx | Meningitis, brain abscess, metabolic encephalopathy, prion disease, psychiatric disorder (anti-NMDA) |
| Treatment | HSV: acyclovir 10 mg/kg IV q8h × 14–21 days; autoimmune: steroids → IVIG → plasma exchange → rituximab |
| Contraindications | Delay in acyclovir pending PCR confirmation is dangerous; lumbar puncture in herniation risk |
| ICU Management | Seizure management; airway; anti-pyretics; ICP monitoring; nutritional support; EEG monitoring |
| OPD Prescription | Complete acyclovir course; anti-epileptics; immunosuppression for autoimmune; neuropsychological rehabilitation |
| Prognosis | HSV with treatment: mortality <20%; without treatment mortality >70%; autoimmune often responds to immunotherapy |
| Diet & Nutrition | High energy/protein; dysphagia management; avoid aspiration; consider tube feeding in prolonged illness |
7. PARKINSON'S DISEASE
| Domain | Details |
|---|---|
| Types | Idiopathic PD; Parkinson-plus syndromes: PSP, MSA, CBS; Drug-induced Parkinsonism; Vascular Parkinsonism |
| Investigations | Clinical diagnosis; MRI brain (hummingbird sign in PSP, hot cross bun in MSA); DaTscan SPECT; NMG, autonomic studies |
| Findings | Bradykinesia + tremor (3–5 Hz, pill-rolling, rest tremor) + rigidity; asymmetric onset; micrographia; reduced arm swing; substantia nigra loss on DaTscan |
| Differential Dx | Essential tremor, PSP, MSA, DLB, drug-induced Parkinsonism, NPH, Wilson's disease |
| Treatment | Levodopa/carbidopa (most effective); dopamine agonists (pramipexole, ropinirole); MAO-B inhibitors (rasagiline, selegiline); COMT inhibitors (entacapone); DBS for advanced disease |
| Contraindications | Antipsychotics (D2 blockers) worsen Parkinsonism; metoclopramide contraindicated; non-selective MAOIs with levodopa |
| ICU Management | Never abruptly stop dopaminergic therapy (risk of NMS-like syndrome); maintain medications orally/NG; treat autonomic instability |
| OPD Prescription | Levodopa 100/25 mg TDS (titrate); or pramipexole 0.125–1 mg TDS; physiotherapy; speech therapy; occupational therapy |
| Prognosis | Progressive; 10–15 yr median to severe disability; DBS improves motor fluctuations; average lifespan near normal with treatment |
| Diet & Nutrition | Protein redistribution diet (reduce protein during day to improve levodopa absorption); high fiber for constipation; adequate hydration; Mediterranean diet |
8. ALZHEIMER'S DISEASE
| Domain | Details |
|---|---|
| Types | Late-onset (>65, sporadic), Early-onset (<65, familial — PSEN1/2, APP mutations); Posterior cortical atrophy variant |
| Investigations | Neuropsychological testing (MMSE, MoCA), MRI (hippocampal/parietal atrophy), PET amyloid/tau, CSF: Aβ42 low, tau high, p-tau high; APOE4 genotyping |
| Findings | Progressive episodic memory loss; visuospatial deficits; language impairment; medial temporal atrophy on MRI; Braak stages |
| Differential Dx | Vascular dementia, DLB (fluctuating cognition, hallucinations, Parkinsonism), FTD, NPH, depression (pseudodementia), B12/thyroid deficiency |
| Treatment | AChE inhibitors: donepezil 5–10 mg OD, rivastigmine, galantamine (mild–moderate); memantine (moderate–severe); lecanemab/donanemab (anti-amyloid — early disease) |
| Contraindications | AChE inhibitors: bradycardia, active peptic ulcer, asthma/COPD; anticholinergic drugs worsen cognition |
| ICU Management | Avoid anticholinergic/benzodiazepine/opioid-heavy regimens (worsens delirium); maintain orientation; one-to-one nursing |
| OPD Prescription | Donepezil 5 mg OD × 4 weeks, then 10 mg OD; memantine 5 mg OD → 20 mg OD; treat BPSD (risperidone low dose if severe agitation) |
| Prognosis | Median survival 8–10 years from diagnosis; faster decline with early onset, APOE4; death usually from aspiration pneumonia or sepsis |
| Diet & Nutrition | MIND diet (Mediterranean + DASH); omega-3 fatty acids; vitamin E; ensure adequate calorie intake; finger foods when utensil use impaired; tube feeding in late stage (controversial) |
9. MULTIPLE SCLEROSIS (MS)
| Domain | Details |
|---|---|
| Types | Relapsing-Remitting (RRMS, 85%), Secondary Progressive (SPMS), Primary Progressive (PPMS), Clinically Isolated Syndrome (CIS) |
| Investigations | MRI brain + spine (McDonald criteria): periventricular, juxtacortical, infratentorial lesions; VEPs (prolonged in optic neuritis); LP: oligoclonal bands; OCT |
| Findings | Lhermitte's sign; Uhthoff's phenomenon (heat sensitivity); Charcot triad (nystagmus, scanning speech, intention tremor); dissemination in space and time on MRI |
| Differential Dx | Neuromyelitis optica (NMOSD — AQP4/MOG Ab), CNS vasculitis, sarcoidosis, B12 deficiency, Lyme disease, SLE |
| Treatment | Acute relapse: IV methylprednisolone 1 g/day × 3–5 days; DMTs: first-line (interferon-β, glatiramer acetate, teriflunomide, dimethyl fumarate); high-efficacy (natalizumab, ocrelizumab, alemtuzumab, cladribine) |
| Contraindications | Natalizumab: JC virus antibody positive (PML risk); alemtuzumab: active infection, malignancy; fingolimod: bradycardia, macular edema risk |
| ICU Management | Respiratory failure (acute myelitis): ventilation; bladder management; pressure care; VTE prophylaxis; treat infections |
| OPD Prescription | DMT (per specialist); baclofen 5–20 mg TDS for spasticity; amantadine 100 mg BD for fatigue; oxybutynin for bladder; amitriptyline for neuropathic pain |
| Prognosis | RRMS: 50% significant disability at 10 years; PPMS worse; better prognosis: female, optic neuritis onset, low lesion burden |
| Diet & Nutrition | Mediterranean diet; vitamin D supplementation (target >50 ng/mL); omega-3; avoid smoking; moderate exercise; maintain healthy weight |
10. MIGRAINE
| Domain | Details |
|---|---|
| Types | Migraine without aura, with aura, chronic migraine (≥15 days/month), hemiplegic, vestibular, retinal, menstrual migraine |
| Investigations | Clinical diagnosis; MRI if red flags (first/worst headache, progressive, focal deficit, age >50, papilledema); no routine investigation needed |
| Findings | Unilateral throbbing headache, photophobia, phonophobia, nausea/vomiting; prodrome (yawning, mood change); aura lasts <60 min |
| Differential Dx | Tension-type headache, cluster headache, SAH (thunderclap), meningitis, cervicogenic headache, glaucoma, sinusitis |
| Treatment | Acute: triptans (sumatriptan 50–100 mg), NSAIDs (ibuprofen 400–600 mg), anti-emetics (metoclopramide); Prevention: propranolol, topiramate, amitriptyline, valproate, CGRP monoclonal antibodies (erenumab, fremanezumab) |
| Contraindications | Triptans: ischemic heart disease, Raynaud's, uncontrolled hypertension, hemiplegic migraine; ergotamines: vasospasm, pregnancy; valproate: pregnancy |
| ICU Management | Rarely needed; status migrainosus: IV dihydroergotamine + anti-emetics, IV valproate, IV magnesium sulfate, IV dexamethasone |
| OPD Prescription | Acute: sumatriptan 50–100 mg at onset; Preventive: propranolol 40–80 mg BD or topiramate 25–100 mg OD; headache diary |
| Prognosis | Benign but disabling; 30–40% improve after age 40; menstrual migraine may worsen perimenstrually; CGRP antibodies highly effective in chronic migraine |
| Diet & Nutrition | Identify triggers: alcohol (red wine, beer), aged cheese, MSG, caffeine; regular meals; hydration; avoid skipping meals; magnesium 400 mg/day supplement |
11. GUILLAIN-BARRÉ SYNDROME (GBS)
| Domain | Details |
|---|---|
| Types | AIDP (most common), AMAN, AMSAN, Miller Fisher syndrome (ataxia, ophthalmoplegia, areflexia — GQ1b Ab) |
| Investigations | CSF: albuminocytological dissociation (high protein, normal WBC); NCS/EMG: demyelination or axonal; anti-GQ1b (Miller Fisher); stool culture for Campylobacter |
| Findings | Ascending flaccid paralysis; areflexia; autonomic instability; respiratory failure (FVC monitoring); preceding infection in 70% |
| Differential Dx | Myasthenia gravis, botulism, West Nile virus, transverse myelitis, critical illness polyneuropathy, polio |
| Treatment | IVIg 0.4 g/kg × 5 days OR plasma exchange × 5 sessions; NOT steroids (no benefit, may worsen); supportive care |
| Contraindications | Steroids (contraindicated — no benefit + potentially harmful); IVIg: IgA deficiency (risk of anaphylaxis) |
| ICU Management | Monitor FVC (intubate if <15–20 mL/kg or declining), autonomic instability (avoid rapid BP changes), DVT prophylaxis, bladder care, nutrition |
| OPD Prescription | Physiotherapy (intensive rehabilitation); gabapentin for neuropathic pain; anti-emetics; laxatives; supportive aids |
| Prognosis | 85% full or near-full recovery; 5% mortality; poor prognosis: rapid onset, axonal form, Campylobacter preceding infection, age >60 |
| Diet & Nutrition | High protein diet; NG feeding if swallowing impaired; adequate calorie intake; thiamine supplementation; rehabilitation diet |
12. MYASTHENIA GRAVIS (MG)
| Domain | Details |
|---|---|
| Types | AChR Ab-positive (85%), MuSK Ab-positive (10%), seronegative; Ocular MG, Generalized MG; Thymoma-associated |
| Investigations | AChR antibodies, MuSK antibodies; edrophonium (Tensilon) test; ice pack test; repetitive nerve stimulation (decremental response); CT chest (thymoma); single-fiber EMG |
| Findings | Fatigable muscle weakness; ptosis; diplopia; bulbar weakness; proximal limb weakness; worse in evening; decremental response on RNS |
| Differential Dx | Lambert-Eaton syndrome (proximal weakness, incremental response, decreased reflexes), botulism, GBS, Miller Fisher, brainstem tumor |
| Treatment | Pyridostigmine (AChE inhibitor); immunosuppression: prednisolone ± azathioprine; thymectomy (thymoma or AChR+ <65 yr); plasma exchange/IVIg for crisis |
| Contraindications | Aminoglycosides, fluoroquinolones, beta-blockers, chloroquine, D-penicillamine, magnesium (all worsen MG) |
| ICU Management | Myasthenic crisis: IVIg or plasma exchange; ventilatory support; hold pyridostigmine (may worsen secretions); treat precipitating cause (infection) |
| OPD Prescription | Pyridostigmine 30–60 mg q4–6h; prednisolone 10–60 mg OD; azathioprine 50–150 mg OD; calcium/vitamin D with steroids; PPI |
| Prognosis | Good with treatment; 80% marked improvement; thymectomy improves long-term outcome; crisis carries 5% mortality |
| Diet & Nutrition | Small frequent meals (avoid fatigue); soft diet if bulbar weakness; adequate protein; avoid foods requiring prolonged chewing |
13. BRAIN TUMOR (Glioblastoma / Primary CNS Tumors)
| Domain | Details |
|---|---|
| Types | WHO grade: I (pilocytic astrocytoma), II (diffuse glioma), III (anaplastic), IV (GBM); Meningioma, CNS lymphoma, Medulloblastoma, Metastases |
| Investigations | MRI brain with gadolinium (ring-enhancing in GBM); CT for calcification (oligodendroglioma); MRS; PET; biopsy for histology/molecular markers (IDH, MGMT, 1p/19q) |
| Findings | Raised ICP: headache worse in morning, vomiting; focal deficits; seizures; GBM: ring-enhancing lesion with central necrosis; butterfly glioma |
| Differential Dx | Brain abscess (ring-enhancing), metastasis, MS (tumefactive), CNS lymphoma, subacute infarct |
| Treatment | GBM: surgical resection + radiotherapy + temozolomide (Stupp protocol); low-grade glioma: watch or surgery; meningioma: resection; CNS lymphoma: high-dose methotrexate |
| Contraindications | Temozolomide in lymphopenia; steroids increase infection risk; anti-epileptics: enzyme-inducing agents reduce chemotherapy efficacy |
| ICU Management | Dexamethasone 4–8 mg q6h for cerebral edema; mannitol for acute herniation; anti-epileptics; nutrition |
| OPD Prescription | Dexamethasone 4 mg QDS (taper after surgery); levetiracetam 500–1000 mg BD; temozolomide per oncology schedule |
| Prognosis | GBM: median survival 14–16 months with Stupp protocol; IDH mutation: significantly better prognosis; MGMT methylation: better chemotherapy response |
| Diet & Nutrition | High calorie/protein; steroids cause hyperglycemia — diabetic diet; anti-nausea during chemotherapy; enteral nutrition if needed |
14. CEREBRAL VENOUS THROMBOSIS (CVT)
| Domain | Details |
|---|---|
| Types | Superior sagittal sinus, lateral sinus, cavernous sinus, cortical vein thrombosis |
| Investigations | MRI + MRV (gold standard); CT venography; D-dimer (raised); thrombophilia screen (protein C/S, antithrombin, Factor V Leiden, lupus anticoagulant) |
| Findings | Empty delta sign on CT; cord sign; bilateral hemorrhagic infarcts; raised ICP; seizures in 40% |
| Differential Dx | Subarachnoid hemorrhage, meningitis, idiopathic intracranial hypertension, migraine, encephalitis |
| Treatment | Anticoagulation: LMWH initially → warfarin for 3–12 months (even if hemorrhagic infarct present); treat underlying cause; anti-epileptics |
| Contraindications | Avoid thrombolytics routinely; LP for raised ICP caution if mass effect |
| ICU Management | ICP management; seizure control; monitor for neurological deterioration; hydration |
| OPD Prescription | Warfarin (target INR 2–3) or DOAC for 3–12 months; anti-epileptics if seizure; treat underlying (OCP discontinuation, dehydration correction) |
| Prognosis | 80% full recovery with treatment; mortality 5–10%; risk of recurrence if thrombophilia present |
| Diet & Nutrition | Adequate hydration (dehydration is a risk factor); vitamin K consistency if on warfarin; avoid smoking/OCP |
15. IDIOPATHIC INTRACRANIAL HYPERTENSION (IIH)
| Domain | Details |
|---|---|
| Types | Primary (idiopathic), Secondary (drugs: tetracyclines, vitamin A, steroids withdrawal) |
| Investigations | MRI brain + MRV (empty sella, slit ventricles, transverse sinus stenosis); LP: opening pressure >25 cm H₂O, normal CSF composition; ophthalmology (papilledema, visual field) |
| Findings | Papilledema; enlarged blind spot; pulsatile tinnitus; headache; no mass lesion; overweight female of childbearing age |
| Differential Dx | CVT, brain tumor, meningitis, hypertensive crisis, sleep apnea-related |
| Treatment | Acetazolamide 250 mg → 2 g/day; weight loss (10% body weight reduces recurrence by 70%); repeated LP; shunting (VP or LS shunt); optic nerve sheath fenestration for visual loss |
| Contraindications | Acetazolamide: sulfonamide allergy, severe hepatic/renal disease; avoid drugs that exacerbate (tetracyclines, vitamin A supplements) |
| ICU Management | Rare; acute visual loss: urgent LP drainage; serial visual fields |
| OPD Prescription | Acetazolamide 250 mg BD → titrate; topiramate 25–100 mg/day (weight loss + ICP lowering); weight management referral |
| Prognosis | Often remits with weight loss; 10% persistent visual loss; recurrence common if weight regained |
| Diet & Nutrition | Calorie-restricted diet for weight loss; low sodium to reduce fluid retention; dietary counselling essential |
16. TRANSIENT ISCHEMIC ATTACK (TIA)
| Domain | Details |
|---|---|
| Types | Amaurosis fugax (retinal TIA), hemispheric TIA, vertebrobasilar TIA |
| Investigations | MRI DWI (detect small infarcts), CT head, ECG, carotid Doppler, echocardiogram, CBC, coagulation, lipid profile, glucose; ABCD2 score |
| Findings | Focal neurological deficit resolving within 24 hrs (usually <1 hr); DWI may show small lesion; possible carotid stenosis |
| Differential Dx | Migraine with aura, partial seizure (Todd's), hypoglycemia, MS, hemiplegic migraine |
| Treatment | Dual antiplatelet: aspirin 300 mg load + clopidogrel 300 mg load, then aspirin 75 mg + clopidogrel 75 mg for 21 days (POINT/CHANCE trial); statins; carotid endarterectomy if >50–70% stenosis |
| Contraindications | Anticoagulation not first-line unless AF; thrombolytics not indicated |
| ICU Management | Urgent management (ABCD2 ≥4: admit); rapid risk stratification; urgent imaging |
| OPD Prescription | Aspirin 75 mg + clopidogrel 75 mg for 21 days then clopidogrel alone or aspirin alone; atorvastatin 40–80 mg; antihypertensive; glucose control |
| Prognosis | 10% risk of stroke within 48 hrs if untreated; ABCD2 score guides risk; urgent treatment reduces risk by 80% |
| Diet & Nutrition | Mediterranean diet; low sodium; control cardiovascular risk factors; stop smoking |
17. PERIPHERAL NEUROPATHY
| Domain | Details |
|---|---|
| Types | Diabetic (length-dependent sensorimotor), CIDP, vasculitic, nutritional (B12, thiamine), hereditary (CMT), toxic (alcohol, drugs), infectious (leprosy) |
| Investigations | NCS/EMG (axonal vs. demyelinating); blood: glucose, HbA1c, B12, folate, TSH, renal/liver function, SPEP, anti-MAG, anti-Hu; biopsy (vasculitic) |
| Findings | Glove and stocking sensory loss; absent ankle jerks; autonomic features; positive Romberg; neuropathic pain |
| Differential Dx | Myelopathy, lumbosacral radiculopathy, GBS (acute), CIDP (chronic), MS |
| Treatment | Treat underlying cause; pain: gabapentin 300–1200 mg TDS, pregabalin 75–300 mg BD, amitriptyline 10–75 mg nocte, duloxetine 60 mg OD; CIDP: IVIg/steroids/plasma exchange |
| Contraindications | Neurotoxic drugs in existing neuropathy (metronidazole, cisplatin, vincristine, amiodarone, alcohol) |
| ICU Management | Rarely needed; if respiratory compromise (phrenic nerve), ventilatory support; dysautonomia management |
| OPD Prescription | Gabapentin 300 mg TDS titrating; or duloxetine 60 mg OD; B12 injections if deficient (hydroxocobalamin 1 mg IM); optimize glucose control |
| Prognosis | Depends on cause; diabetic neuropathy progresses with poor glucose control; B12 neuropathy reversible early; CMT: slowly progressive |
| Diet & Nutrition | Adequate B12 (meat, dairy, fortified foods), thiamine (wholegrains), avoid alcohol; optimal glucose management in diabetes |
18. MOTOR NEURON DISEASE (ALS)
| Domain | Details |
|---|---|
| Types | ALS (mixed UMN+LMN), PLS (UMN), PMA (LMN), Progressive Bulbar Palsy; Familial (SOD1, C9orf72 mutations) |
| Investigations | EMG/NCS (widespread denervation, normal sensory); MRI spine/brain (exclude other causes); El Escorial criteria; genetic testing (SOD1, C9orf72); pulmonary function (FVC) |
| Findings | Fasciculations; muscle atrophy; hyperreflexia; Babinski; dysarthria; dysphagia; respiratory failure; no sensory loss; cognitive changes (FTD overlap) |
| Differential Dx | Multifocal motor neuropathy (treatable), Kennedy disease (SBMA), myelopathy, GBS, post-polio syndrome, heavy metal toxicity |
| Treatment | Riluzole 50 mg BD (modestly prolongs survival by ~3 months); edaravone (oxidative stress); supportive: NIV for respiratory failure; PEG for nutrition; baclofen for spasticity; MDT approach |
| Contraindications | Riluzole: hepatotoxicity monitoring required; avoid drugs worsening respiratory depression; PEG safer when FVC >50% |
| ICU Management | NIV/BiPAP; airway secretion management; gastrostomy feeding; palliative care discussion |
| OPD Prescription | Riluzole 50 mg BD; baclofen 5–20 mg TDS; gabapentin for pain; glycopyrrolate for drooling; NIV referral; PEG referral |
| Prognosis | Median survival 2–4 years from symptom onset; respiratory failure is usual cause of death; bulbar onset worse prognosis |
| Diet & Nutrition | High calorie/high fat diet (neuroprotective evidence); PEG feeding when FVC <50% or dysphagia; avoid aspiration; adequate hydration |
19. HUNTINGTON'S DISEASE
| Domain | Details |
|---|---|
| Types | Classic (adult onset, CAG repeat 40–55); Juvenile Westphal variant (<20 yrs, predominantly rigid, CAG >60) |
| Investigations | Genetic testing: CAG repeat expansion >36 in HTT gene (confirmatory); MRI: caudate atrophy (boxing glove sign); neuropsychological testing |
| Findings | Choreiform movements; personality/cognitive changes; psychiatric symptoms (depression, psychosis); dysphagia; motor disorder |
| Differential Dx | Sydenham's chorea, SLE chorea, drug-induced chorea (tardive dyskinesia), benign hereditary chorea, dentatorubropallidoluysian atrophy (DRPLA) |
| Treatment | Chorea: tetrabenazine 12.5–50 mg TDS or deutetrabenazine; antipsychotics (olanzapine, risperidone) for chorea + psychiatric symptoms; anti-depressants; gene silencing therapies (tominersen — in trials) |
| Contraindications | Tetrabenazine: depression (risk of suicidality), active hepatic disease; avoid haloperidol if depression present |
| ICU Management | Severe chorea-induced injury; aspiration pneumonia; acute psychiatric crisis; nutritional support |
| OPD Prescription | Tetrabenazine 12.5 mg OD → TDS titration; olanzapine 5–10 mg OD; sertraline 50–200 mg for depression; physiotherapy; genetic counselling |
| Prognosis | Progressive; death 15–20 years after onset; suicide risk 5–10%; aspiration pneumonia is leading cause of death |
| Diet & Nutrition | Very high calorie diet (chorea increases metabolic rate significantly); frequent small meals; thickened fluids/soft diet as dysphagia progresses; PEG eventually needed |
20. WILSON'S DISEASE
| Domain | Details |
|---|---|
| Types | Hepatic presentation, Neurological presentation, Psychiatric presentation, Mixed |
| Investigations | Serum ceruloplasmin (low <20 mg/dL), 24-hr urine copper (high >100 μg/day), slit-lamp (Kayser-Fleischer rings), MRI brain (basal ganglia T2 hyperintensity, face of the giant panda sign), liver biopsy (hepatic copper >250 μg/g dry weight), genetic testing (ATP7B) |
| Findings | KF rings; "wing-beating" tremor; dysarthria; dystonia; Parkinsonism; psychiatric symptoms; hepatic cirrhosis |
| Differential Dx | Parkinson's disease, Huntington's disease, early-onset dystonia, liver cirrhosis from other causes, psychiatric disorders |
| Treatment | D-penicillamine (chelation, first-line, side effects: lupus, nephrotic); trientine (fewer side effects); zinc acetate (blocks absorption); liver transplant (fulminant or failed medical therapy) |
| Contraindications | Penicillamine in neurological Wilson's (paradoxical worsening in 20–50%); penicillamine + penicillin allergy cross-reactivity |
| ICU Management | Acute liver failure: liver transplant assessment; fresh frozen plasma; coagulopathy correction; encephalopathy management |
| OPD Prescription | Trientine 300 mg TDS or D-penicillamine 250–500 mg QDS; zinc acetate 50 mg TDS for maintenance; monitor 24-hr urine copper, LFT, FBC |
| Prognosis | Excellent with early treatment; neurological symptoms reversible in 50%; liver disease can stabilize; lifelong treatment needed |
| Diet & Nutrition | Low copper diet: avoid shellfish, liver, nuts, mushrooms, chocolate; boil water (copper pipes); adequate zinc intake |
21. NORMAL PRESSURE HYDROCEPHALUS (NPH)
| Domain | Details |
|---|---|
| Types | Idiopathic (primary), Secondary (post-meningitis, subarachnoid hemorrhage, trauma) |
| Investigations | CT/MRI brain: ventriculomegaly (Evans index >0.3) out of proportion to sulcal atrophy; LP: opening pressure normal, CSF tap test (improvement post-LP); cisternography |
| Findings | Hakim's triad: gait apraxia (magnetic gait), urinary incontinence, dementia; CSF pressure 5–18 cm H₂O; periventricular lucency |
| Differential Dx | Alzheimer's disease, Parkinson's disease, vascular dementia, cervical myelopathy |
| Treatment | Ventriculoperitoneal (VP) shunt (definitive); programmable shunt; serial lumbar punctures for diagnostic purpose |
| Contraindications | LP if CSF pressure >25 cm H₂O; shunting in poor surgical candidates |
| ICU Management | Post-shunt monitoring for over-drainage, subdural hematoma, infection; ICP monitoring |
| OPD Prescription | Physiotherapy (gait training); shunt setting review; bladder training; cognitive support |
| Prognosis | 60–80% improve with shunting, especially gait; cognition less predictably improved; urinary incontinence intermediate response |
| Diet & Nutrition | No specific dietary restriction; adequate hydration; avoid excess fluid retention |
22. NEUROFIBROMATOSIS
| Domain | Details |
|---|---|
| Types | NF1 (von Recklinghausen, chromosome 17), NF2 (chromosome 22 — bilateral acoustic neuromas), Schwannomatosis |
| Investigations | Clinical diagnosis (NIH criteria); MRI brain/spine; slit-lamp (Lisch nodules in NF1); genetic testing (NF1/NF2 mutations); audiometry (NF2); ophthalmology |
| Findings | NF1: ≥6 café-au-lait spots >5mm; axillary/inguinal freckling; Lisch nodules; neurofibromas; optic glioma; NF2: bilateral vestibular schwannomas |
| Differential Dx | McCune-Albright syndrome (café-au-lait without neurofibromas), Legius syndrome, LEOPARD syndrome, other phakomatoses |
| Treatment | Selumetinib (MEK inhibitor) for inoperable plexiform neurofibromas in NF1; surgical excision; NF2: microsurgery or stereotactic radiosurgery for schwannomas; bevacizumab for NF2 |
| Contraindications | Radiotherapy increases risk of malignant transformation in NF1; selumetinib: cardiac toxicity monitoring |
| ICU Management | Post-operative monitoring; spinal cord compression; respiratory compromise from thoracic neurofibromas |
| OPD Prescription | Annual surveillance MRI; audiometry; ophthalmology review; selumetinib per protocol; genetic counselling |
| Prognosis | NF1: near-normal life expectancy but 8–10 yr reduction; 10% develop malignant peripheral nerve sheath tumor; NF2: significant morbidity from hearing loss |
| Diet & Nutrition | No specific restriction; healthy balanced diet; calcium/vitamin D if on long-term steroids |
23. CEREBRAL PALSY (CP)
| Domain | Details |
|---|---|
| Types | Spastic (hemiplegia, diplegia, quadriplegia), Dyskinetic (choreoathetoid, dystonic), Ataxic, Mixed |
| Investigations | MRI brain (periventricular leukomalacia in preterm, HIE changes in term); EEG if seizures; developmental assessment; GMFCS classification; vision/hearing screening |
| Findings | Motor delay; tone abnormality; persistence of primitive reflexes; scissor gait; associated: epilepsy (30%), intellectual disability (50%), visual impairment |
| Differential Dx | Metabolic disorders (organic acidurias), genetic conditions (Angelman, Rett), neurodegenerative diseases, spinal cord abnormalities |
| Treatment | Multidisciplinary: physiotherapy, occupational therapy, speech therapy; Spasticity: baclofen (oral/intrathecal), botulinum toxin A, selective dorsal rhizotomy; anti-epileptics; orthotics |
| Contraindications | Intrathecal baclofen: spinal infection, coagulopathy; botulinum toxin: MG, infection at injection site |
| ICU Management | Status epilepticus protocol; respiratory management; aspiration pneumonia treatment; nutritional support via PEG |
| OPD Prescription | Baclofen 5–20 mg TDS; or tizanidine 2–8 mg TDS; botulinum toxin every 3 months; levetiracetam if seizures; PEG feeding if malnutrition |
| Prognosis | Non-progressive brain injury but evolving functional disability; life expectancy varies with severity; independent living possible in mild CP |
| Diet & Nutrition | High calorie needs due to abnormal muscle tone; risk of malnutrition; dysphagia management; PEG feeding in severe cases; calcium/vitamin D for bone health |
24. TRIGEMINAL NEURALGIA
| Domain | Details |
|---|---|
| Types | Classic (vascular compression of CN V), Idiopathic, Secondary (MS, tumor, AVM) |
| Investigations | MRI brain with CISS/FIESTA sequence (neurovascular conflict, MS plaques, tumor); clinical diagnosis by IHS criteria |
| Findings | Unilateral electric shock-like facial pain, V2/V3 distribution, triggered by touch/eating/cold, pain-free intervals; no sensory loss in classic form |
| Differential Dx | SUNCT/SUNA, cluster headache, dental pain, glossopharyngeal neuralgia, postherpetic neuralgia, atypical facial pain, MS |
| Treatment | Carbamazepine 100–800 mg BD (first-line); oxcarbazepine; gabapentin; baclofen; Surgical: microvascular decompression (MVD — best long-term results), stereotactic radiosurgery, glycerol injection, balloon compression |
| Contraindications | Carbamazepine: hyponatremia, bone marrow suppression, HLA-B*1502 (Stevens-Johnson risk in Asian populations — test before prescribing) |
| ICU Management | Rarely needed; severe dehydration from inability to eat/drink; pain crisis management |
| OPD Prescription | Carbamazepine 100 mg BD → 400–800 mg BD titration; blood count monitoring; surgical referral if medically refractory |
| Prognosis | 75% initial response to carbamazepine; tolerance develops; MVD curative in 80–90% for 5+ years; secondary TN depends on underlying cause |
| Diet & Nutrition | Soft/liquid diet to avoid trigger; nutritional supplementation if intake restricted; warm foods may aggravate pain; cold triggers common |
25. BELL'S PALSY
| Domain | Details |
|---|---|
| Types | Idiopathic (Bell's palsy), HSV-1 reactivation (most accepted theory), Ramsay Hunt syndrome (VZV reactivation — zoster oticus) |
| Investigations | Clinical diagnosis; if atypical: MRI brain + internal auditory canal with gadolinium; EMG (denervation); Lyme serology if endemic area; blood glucose; audiometry |
| Findings | Unilateral LMN facial palsy (forehead sparing = UMN, involved = LMN); Bell's phenomenon; hyperacusis; loss of taste (anterior 2/3 tongue); House-Brackmann grading |
| Differential Dx | Ramsay Hunt (vesicles in ear), brain tumor, stroke (UMN — forehead spared), sarcoidosis (bilateral), Lyme disease, parotid tumor, MS |
| Treatment | Prednisolone 50 mg OD × 10 days (within 72 hrs of onset — improves recovery significantly); acyclovir 800 mg 5× daily if Ramsay Hunt/severe; eye care (lubricants, patching) |
| Contraindications | Steroids: uncontrolled diabetes, active peptic ulcer, severe infection; delay beyond 72 hrs reduces benefit |
| ICU Management | Rarely required; corneal protection is mandatory |
| OPD Prescription | Prednisolone 50 mg OD × 10 days; eye drops (hypromellose) QDS; eye ointment at night; eye patch if incomplete closure; physiotherapy (facial exercises) |
| Prognosis | 85% complete recovery within 3 months with steroids; 15% partial/incomplete recovery; House-Brackmann grade I–II at 3 weeks = good prognosis |
| Diet & Nutrition | No specific restriction; soft diet if facial weakness impairs chewing; adequate hydration |
26. SPINAL CORD INJURY
| Domain | Details |
|---|---|
| Types | Complete (ASIA A), Incomplete (ASIA B–D): Central cord syndrome, Brown-Séquard, anterior cord syndrome, posterior cord syndrome; by level: cervical, thoracic, lumbar |
| Investigations | MRI spine (gold standard — cord compression, hemorrhage, edema); CT spine (bony injury); ASIA/ISNCSCI assessment; bladder/bowel assessment; urodynamics |
| Findings | Spinal shock (flaccid paralysis initially); return of reflexes; autonomic dysreflexia (in lesions above T6); neurogenic bladder; pressure sores |
| Differential Dx | Transverse myelitis, epidural abscess, hemorrhage, tumor compression, GBS, MS, aortic dissection |
| Treatment | Acute: immobilization; surgery for compression (within 24 hrs); methylprednisolone controversial; rehabilitation (intensive MDT); FES; baclofen for spasticity; intermittent catheterization |
| Contraindications | High-dose methylprednisolone no longer recommended (NASCIS III — more harm); indiscriminate mobilization before stabilization |
| ICU Management | Respiratory support (C3–5 injury: diaphragm paralysis, need ventilation); blood pressure support (neurogenic shock); temperature regulation; prevent autonomic dysreflexia |
| OPD Prescription | Baclofen 5–20 mg TDS; oxybutynin 5–10 mg TDS for neurogenic bladder; stool softeners; DVT prophylaxis; pressure ulcer prevention; physiotherapy |
| Prognosis | Complete injury: poor motor recovery below level; incomplete injury: variable but 50–75% have some functional recovery; central cord: best incomplete prognosis |
| Diet & Nutrition | High calorie initially (acute stress); high protein (1.5–2 g/kg); high fiber + adequate fluids for bowel; calcium/vitamin D for osteoporosis prevention; weight management long-term |
27. NARCOLEPSY
| Domain | Details |
|---|---|
| Types | Type 1 (with cataplexy, low CSF hypocretin), Type 2 (without cataplexy, normal hypocretin) |
| Investigations | Polysomnography (PSG) followed by MSLT (mean sleep latency <8 min, ≥2 SOREMPs); CSF hypocretin-1 <110 pg/mL (Type 1); HLA DQB1*0602; thyroid, glucose, sleep apnea exclusion |
| Findings | Excessive daytime sleepiness; cataplexy (bilateral muscle weakness triggered by emotion); sleep paralysis; hypnagogic/hypnopompic hallucinations; REM intrusion |
| Differential Dx | Idiopathic hypersomnia, sleep apnea, seizures, Klein-Levin syndrome, psychiatric hypersomnia, circadian rhythm disorder |
| Treatment | Excessive sleepiness: modafinil 100–400 mg OD (first-line), sodium oxybate (GHB), amphetamines; Cataplexy: sodium oxybate, venlafaxine, fluoxetine, clomipramine; pitolisant (histamine agonist) |
| Contraindications | Stimulants: cardiovascular disease, hypertension, anxiety disorders, drug abuse history; sodium oxybate: alcohol, CNS depressants, urea cycle disorders |
| ICU Management | Rarely needed; perioperative management (stimulant dosing) |
| OPD Prescription | Modafinil 200 mg in morning (or split dose); venlafaxine 75 mg for cataplexy; sleep hygiene counselling; scheduled naps; driving restrictions |
| Prognosis | Lifelong condition; adequate control with medications in most; rare spontaneous remission; significant impact on quality of life and occupation |
| Diet & Nutrition | Small frequent meals (avoid large carbohydrate meals which worsen sleepiness); caffeine strategically; avoid alcohol; maintain healthy weight (obesity worsens); regular sleep schedule |
28. NEUROMYELITIS OPTICA SPECTRUM DISORDER (NMOSD)
| Domain | Details |
|---|---|
| Types | AQP4-IgG seropositive (most common), MOG-IgG associated (MOGAD), seronegative NMOSD |
| Investigations | AQP4-IgG antibody (send at relapse before immunotherapy); MOG-IgG; MRI brain + spine (longitudinally extensive transverse myelitis ≥3 vertebral segments); VEPs |
| Findings | Severe optic neuritis (often bilateral/sequential); longitudinally extensive myelitis; area postrema syndrome (intractable hiccups/vomiting); poor visual recovery |
| Differential Dx | Multiple sclerosis (shorter cord lesions, better recovery), MS optic neuritis (unilateral, better outcome), CNS sarcoidosis, paraneoplastic myelitis, infectious myelitis |
| Treatment | Acute: IV methylprednisolone 1 g × 5 days + plasma exchange if severe; Prevention: azathioprine, mycophenolate mofetil; Biologic DMTs: eculizumab, inebilizumab, satralizumab (AQP4+); rituximab |
| Contraindications | Interferon-β and natalizumab may worsen NMOSD — AVOID in NMOSD; fingolimod may also worsen |
| ICU Management | Respiratory failure from myelitis; severe vision loss management; pain control; bladder/bowel care |
| OPD Prescription | Azathioprine 2–3 mg/kg OD (most available option); rituximab 1 g IV every 6 months; physiotherapy; pain management |
| Prognosis | More severe and relapsing than MS; AQP4+ has worse outcome; high risk of blindness/paraplegia; treatment reduces relapse rate significantly |
| Diet & Nutrition | Adequate protein; vitamin D supplementation; anti-inflammatory diet; bone protection with steroids |
29. PRION DISEASE (Creutzfeldt-Jakob Disease — CJD)
| Domain | Details |
|---|---|
| Types | Sporadic CJD (sCJD, 85%), Familial CJD, Iatrogenic CJD, Variant CJD (vCJD — BSE-linked), Gerstmann-Sträussler-Scheinker, Fatal Familial Insomnia |
| Investigations | MRI DWI/FLAIR: cortical ribboning and basal ganglia signal (sCJD); 14-3-3 protein in CSF; RT-QuIC (highly sensitive, near 100% specificity); EEG (periodic sharp wave complexes in sCJD); PRNP gene testing |
| Findings | Rapidly progressive dementia; cerebellar ataxia; myoclonus; cortical visual disturbance; akinetic mutism late; vCJD: psychiatric onset, younger age, pulvinar sign on MRI |
| Differential Dx | Alzheimer's disease, autoimmune encephalitis (anti-NMDA, anti-LGI1), Lewy body dementia, toxic/metabolic encephalopathy, lymphoma |
| Treatment | No effective treatment; palliative/supportive care; pain management; seizure control; anxiolytics |
| Contraindications | No specific; must notify public health authorities; biohazard precautions (prion-resistant to standard sterilization) |
| ICU Management | Avoid unless for comfort; standard isolation not needed (not airborne) but tissue handling precautions; comfort-focused care |
| OPD Prescription | Supportive: clonazepam for myoclonus; anti-epileptics; adequate analgesia; palliative care referral; carer support |
| Prognosis | Invariably fatal; sCJD median survival 4–6 months; vCJD slightly longer (13 months); always fatal |
| Diet & Nutrition | Maintain nutrition and hydration as long as safe; dysphagia management; PEG or NG tube for comfort in late stage; palliative nutrition approach |
30. TUBEROUS SCLEROSIS COMPLEX (TSC)
| Domain | Details |
|---|---|
| Types | TSC1 (hamartin, chromosome 9), TSC2 (tuberin, chromosome 16); Sporadic or Autosomal Dominant |
| Investigations | MRI brain (cortical tubers, subependymal nodules, SEGA); EEG (infantile spasms, multiple seizure types); renal ultrasound/CT (AML); echocardiography (rhabdomyoma); ophthalmology (astrocytic hamartoma); skin exam; FEV/DLCO (LAM in females); genetic testing (TSC1/TSC2) |
| Findings | Ash-leaf spots (hypomelanotic macules), shagreen patches, facial angiofibromas, ungual fibromas, subependymal giant cell astrocytoma (SEGA), seizures (80%), intellectual disability, autism (50%) |
| Differential Dx | NF1 (café-au-lait, no cortical tubers), isolated cortical dysplasia, other phakomatoses, vitiligo (for skin) |
| Treatment | Seizures: vigabatrin (first-line for infantile spasms in TSC), levetiracetam, other AEDs; SEGA: everolimus (mTOR inhibitor) or surgical resection; Renal AML >3 cm: embolization or everolimus; Skin: laser treatment; LAM: everolimus, sirolimus |
| Contraindications | Everolimus: active serious infections, pregnancy; vigabatrin: visual field defects monitoring required |
| ICU Management | Status epilepticus (TSC patients at high risk); SEGA-related acute hydrocephalus; respiratory failure (LAM) |
| OPD Prescription | Vigabatrin 50–150 mg/kg/day in children for infantile spasms; everolimus 4.5 mg/m² BD for SEGA; annual surveillance MRI/ultrasound; multidisciplinary follow-up |
| Prognosis | Variable; TSC2 mutations more severe; SEGA can cause hydrocephalus and death if untreated; mTOR inhibitors significantly improve outcomes; near-normal life expectancy in mild cases |
| Diet & Nutrition | Ketogenic diet effective for drug-resistant seizures in TSC; adequate nutrition during vigabatrin/everolimus therapy; avoid excessive vitamin A |
QUICK REFERENCE SUMMARY TABLE
| # | Disease | Key Drug(s) | Critical Contraindication | ICU Priority |
|---|---|---|---|---|
| 1 | Ischemic Stroke | tPA, aspirin | BP >185/110 for tPA | BP control, airway |
| 2 | ICH | Reverse anticoagulation | Thrombolytics | ICP management |
| 3 | SAH | Nimodipine | NSAIDs, hypotension | Vasospasm monitoring |
| 4 | Epilepsy | Levetiracetam, valproate | Carbamazepine in generalized | Status epilepticus protocol |
| 5 | Bacterial Meningitis | Ceftriaxone + dexamethasone | LP if papilledema | Steroids reduce mortality |
| 6 | Encephalitis | Acyclovir | Delay in treatment | Seizure + ICP control |
| 7 | Parkinson's | Levodopa/carbidopa | Antipsychotics, metoclopramide | Never stop dopaminergics |
| 8 | Alzheimer's | Donepezil, memantine | Anticholinergics | Avoid benzodiazepines |
| 9 | MS | IFN-β, natalizumab, ocrelizumab | Interferon in NMOSD (wrong dx) | Respiratory support |
| 10 | Migraine | Triptans, propranolol | Triptans in IHD | IV DHE + anti-emetics |
| 11 | GBS | IVIg, plasma exchange | Steroids (harmful) | FVC monitoring |
| 12 | Myasthenia Gravis | Pyridostigmine, steroids | Aminoglycosides, beta-blockers | IVIg/plasma exchange in crisis |
| 13 | Brain Tumor | Temozolomide, dexamethasone | Enzyme-inducing AEDs | Cerebral edema control |
| 14 | CVT | Anticoagulation (LMWH→warfarin) | Routine thrombolytics | ICP management |
| 15 | IIH | Acetazolamide | Acetazolamide in sulfonamide allergy | Serial LP if vision threatened |
| 16 | TIA | Dual antiplatelets, statin | Thrombolytics not indicated | Urgent risk stratification |
| 17 | Neuropathy | Gabapentin, treat cause | Neurotoxic drugs | Respiratory support |
| 18 | ALS | Riluzole, NIV | Delay in NIV | BiPAP, PEG nutrition |
| 19 | Huntington's | Tetrabenazine, olanzapine | Tetrabenazine in depression | Aspiration care |
| 20 | Wilson's | Trientine, penicillamine, zinc | Penicillamine in neuro-Wilson's | Liver transplant assessment |
| 21 | NPH | VP shunt | LP if high pressure (>25 cm H₂O) | Post-shunt overdrainage |
| 22 | Neurofibromatosis | Selumetinib (NF1), bevacizumab (NF2) | Radiotherapy in NF1 | Post-op monitoring |
| 23 | Cerebral Palsy | Baclofen, botulinum toxin | Intrathecal baclofen: spinal infection | Seizure, aspiration |
| 24 | Trigeminal Neuralgia | Carbamazepine | HLA-B*1502 (SJS risk) | Dehydration crisis |
| 25 | Bell's Palsy | Prednisolone, acyclovir | Steroids beyond 72 hrs less effective | Eye care mandatory |
| 26 | Spinal Cord Injury | Rehabilitation, baclofen | High-dose methylprednisolone now avoided | Respiratory, autonomic dysreflexia |
| 27 | Narcolepsy | Modafinil, sodium oxybate | Oxybate + alcohol | Perioperative stimulant management |
| 28 | NMOSD | Eculizumab, rituximab, azathioprine | Interferon-β, natalizumab (worsen) | Plasma exchange |
| 29 | CJD (Prion) | Supportive/palliative only | — | Comfort care; biohazard precautions |
| 30 | Tuberous Sclerosis | Vigabatrin, everolimus | Everolimus: active infection | Status epilepticus, hydrocephalus |
KEY DIETARY PRINCIPLES ACROSS NEUROLOGICAL DISEASES
| Condition Category | Dietary Approach |
|---|---|
| Vascular (stroke, TIA) | Mediterranean/DASH, low sodium (<2 g/day), low saturated fat |
| Epilepsy (drug-resistant) | Ketogenic diet (4:1 ratio), regular meal timing |
| Parkinson's disease | Protein redistribution diet, high fiber, adequate hydration |
| Alzheimer's/Dementia | MIND diet, omega-3, vitamin E, finger foods, prevent malnutrition |
| ALS/MND | High calorie + high fat, PEG when FVC <50% |
| Huntington's disease | Very high calorie intake (hyperkinesia increases metabolic demand) |
| Wilson's disease | Low copper diet (avoid shellfish, liver, nuts, chocolate) |
| MS/NMOSD | Vitamin D supplementation, anti-inflammatory diet |
| Migraine | Trigger avoidance, regular meals, magnesium 400 mg/day, hydration |
| General neurological | High protein for recovery, dysphagia assessment before oral feeding |
Sources: Bradley and Daroff's Neurology in Clinical Practice; Adams and Victor's Principles of Neurology, 12th Edition; Plum and Posner's Diagnosis and Treatment of Stupor and Coma
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