NEET PG Neurology (Medicine) - High-Yield Topics & Questions

1. Ischemic Stroke & Thrombolysis

Must-Know Facts

Key Contraindications to rtPA

• Active bleeding / bleeding diathesis
• Recent head injury or intracerebral hemorrhage
• Major surgery in preceding 14 days
• GI bleeding in preceding 21 days
• CT showing hemorrhage or edema >1/3 of MCA territory

NEET PG pearl: In Japan/Asia, 0.6 mg/kg is used (lower hemorrhage risk). Time of onset = time patient was last seen normal (not time found). - Harrison's Principles of Internal Medicine 22E (2025)

Common MCQ Stem

2. Status Epilepticus

Treatment Ladder (Standard Sequence)

Step 1 (0-5 min):    Lorazepam 0.1 mg/kg IV  (most effective 1st-line)
Step 2 (5-20 min):   Phenytoin / Fosphenytoin / Levetiracetam / Valproate
Step 3 (>20 min):    General anaesthesia (Propofol / Midazolam / Pentobarbitone)

• Lorazepam terminates convulsive SE within 20 minutes in 64.9% of patients (VA Cooperative Study)
• If no IV access available: Intramuscular midazolam is at least as effective as IV lorazepam (and faster to administer)
• Always give IV thiamine before glucose if alcoholism/malnutrition suspected
• Levetiracetam, valproate, and fosphenytoin are equally effective for benzodiazepine-refractory SE

Bradley and Daroff's Neurology in Clinical Practice; Katzung's Basic and Clinical Pharmacology, 16th Ed

3. Parkinson's Disease

Drug Selection by Stage

Common MCQ traps

• Levodopa alone (without carbidopa) causes more nausea and vomiting
• Carbidopa does NOT have anti-Parkinson effect on its own
• On-Off phenomenon, wearing off, dyskinesias = long-term levodopa complications

4. Meningitis - CSF Differentiation

NEET PG pearl: CSF lactate is a high-yield differentiator - elevated in bacterial meningitis, normal in viral. - Tietz Textbook of Laboratory Medicine 7th Ed; Harrison's

5. Migraine Management

6. Other High-Yield Neurology Topics

Myasthenia Gravis

• Autoantibody: Anti-AChR (most common); anti-MuSK in seronegative cases
• Edrophonium (Tensilon) test: short-acting AChE inhibitor used for diagnosis
• Treatment: Pyridostigmine (AChE inhibitor) + immunosuppression
• Myasthenic crisis vs. Cholinergic crisis: both cause weakness; cholinergic crisis has SLUDGE signs (Salivation, Lacrimation, Urination, Defecation, GI, Emesis)
• CT chest mandatory: ~15% have thymoma

Guillain-Barre Syndrome (GBS)

• Ascending flaccid paralysis, areflexia
• CSF: Cytoalbuminous dissociation (elevated protein, normal WBC - classic NEET PG MCQ)
• Triggered by: Campylobacter jejuni (most common), CMV, EBV
• Treatment: IVIG or plasmapheresis (NOT steroids)
• Anti-GQ1b antibodies: Miller-Fisher variant (ophthalmoplegia, ataxia, areflexia)

Multiple Sclerosis

• Demyelinating disease; young females; relapsing-remitting most common
• MRI: Periventricular plaques (Dawson's fingers)
• CSF: Oligoclonal bands (IgG)
• Uhthoff's phenomenon: worsening with heat
• Lhermitte's sign: electric shock sensation on neck flexion
• Treatment: Beta-interferon, Glatiramer acetate (disease-modifying)

Subarachnoid Hemorrhage (SAH)

• "Worst headache of life" - thunderclap headache
• CT brain: Hyperdense blood in basal cisterns
• If CT negative + high suspicion: Lumbar puncture - xanthochromia after 12 hours
• Most common cause of spontaneous SAH: Berry (saccular) aneurysm (Circle of Willis)
• Treatment: Nimodipine (Ca2+ channel blocker) to prevent vasospasm

Cranial Nerve Palsies - Quick MCQ Review

NEET PG Paper Pattern for Neurology

• Medicine carries ~30 questions (15% of NEET PG) - NEET PG 2025 Analysis
• Neurology + Cardiology = highest-yield within Medicine
• Questions are increasingly clinical vignette-based (not direct recall)
• Over 50% are image-integrated or case-based
• ~30% of questions are repeats or close variants of previous year questions

Recommended Study Approach

1. Solve last 10 years of PYQs (NEET PG + AIIMS + USMLE-style) for neurology
2. Focus on numbers: rtPA dose, SE treatment timings, CSF values
3. For clinical cases: always think through - diagnosis → investigation → management
4. Read Harrison's neurology chapters for stroke, meningitis, epilepsy
5. Bradley's Neurology for detailed SE management and cranial nerve disorders