Transient Ischaemic Attack (TIA)

•    Definition:

o    Sudden focal neurological deficit lasting <24 hours (usually <1 hour), no infarct seen on imaging.

•    ABCD2 score:

o    Age ≥60 (1 point)

o    BP ≥140/90 (1 point)

o    Clinical features: unilateral weakness (2), speech disturbance without weakness (1)

o    Duration ≥60 min (2), 10–59 min (1)

o    Diabetes (1)

•    Secondary prevention:

o    High-dose aspirin immediately.

o    Specialist assessment within 24h if high-risk.

o    Carotid Doppler if anterior circulation.

Stroke

•    Ischaemic (~85%) vs haemorrhagic (~15%).

•    Acute management:

o    CT head first to exclude bleed before thrombolysis.

o    Thrombolysis window: <4.5 hours (alteplase).

o    Thrombectomy: large vessel occlusion up to 6h (select cases to 24h).

•    Blood pressure:

o    Avoid aggressive lowering unless >185/110 mmHg pre-thrombolysis or very high.

•    Secondary prevention:

o    Antiplatelet (clopidogrel first-line).

o    Statin (avoid starting within 48h of stroke).

o    BP control.

•    Lacunar stroke:

o    Pure motor or pure sensory stroke, due to small vessel disease.

Subarachnoid Haemorrhage (SAH)

•    Presentation:

o    Sudden "thunderclap" headache ("worst ever"), neck stiffness, photophobia, reduced consciousness.

•    Diagnosis:

o    Non-contrast CT head (high sensitivity in first 6h).

o    If negative: lumbar puncture ≥12h post-onset → xanthochromia (bilirubin breakdown).

•    Causes:

o    Berry aneurysm rupture (e.g., at circle of Willis).

o    AVM (less common).

•    Management:

o    Nimodipine (reduces vasospasm risk).

o    Neurosurgical coiling/clipping.

•    Complications:

o    Rebleed (first 24h), hydrocephalus, vasospasm (4–14 days).

Headache Syndromes

Migraine

•    Unilateral, pulsatile, photophobia, nausea.

•    Aura (visual, sensory, speech disturbance) → resolves before headache.

Cluster headache

•    Severe periorbital pain, lacrimation, nasal congestion.

•    Male predominance, restless during attacks.

•    Acute Rx: high-flow O₂, subcutaneous sumatriptan.

•    Prophylaxis: verapamil.

Red flags ("SNOOP"):

•    Systemic symptoms (fever, weight loss)

•    Neurological signs

•    Onset sudden ("thunderclap")

•    Older age (>50)

•    Progressive or positional

Benign Intracranial Hypertension (IIH)

•    Features:

o    Young obese female.

o    Headache, transient visual obscurations, pulsatile tinnitus.

o    Papilloedema; risk of vision loss.

•    Diagnosis:

o    Normal MRI/CT (exclude mass).

o    Elevated CSF opening pressure (>25 cm H₂O) on LP.

•    Management:

o    Weight loss, acetazolamide.

o    Urgent ophthalmology if visual threat.

Wernicke’s Encephalopathy

•    Classic triad:

o    Confusion.

o    Ataxia (gait).

o    Ophthalmoplegia (nystagmus, lateral rectus palsy).

•    Cause:

o    Thiamine (B1) deficiency → chronic alcohol use, hyperemesis.

•    Management:

o    IV thiamine before glucose.

•    If untreated → Korsakoff’s syndrome (irreversible amnesia, confabulation).

Brain Tumours

•    Presentation:

o    Raised ICP: headache (worse AM), nausea, papilloedema.

o    Focal deficits, new-onset seizures.

•    Common tumours:

o    Glioblastoma multiforme (most common primary adult).

o    Meningioma (extra-axial, often benign).

o    Mets: lung, breast, melanoma (most common overall cause).

•    Management:

o    Dexamethasone for oedema.

Normal Pressure Hydrocephalus (NPH)

•    Classic triad:

o    Gait disturbance ("magnetic gait").

o    Urinary incontinence.

o    Cognitive impairment (dementia).

•    Diagnosis:

o    Ventricular enlargement on imaging; normal opening pressure on LP.

•    Management:

o    High-volume LP (tap test) for prognostication.

o    Ventriculoperitoneal shunt.

Cerebral Venous Sinus Thrombosis (CVST)

•    Presentation:

o    Young woman (pregnancy, OCP).

o    Headache, papilloedema ± seizures.

•    Diagnosis:

o    MR venography.

•    Management:

o    Anticoagulation (LMWH → warfarin/DOAC).

Extra Revision Pearls

•    TIA → "FAST" resolves → carotid Doppler if anterior circulation; consider endarterectomy if >70% stenosis.

•    SAH → watch for vasospasm; nimodipine reduces delayed ischaemia.

•    IIH clue → "fat female with papilloedema, normal scan."

•    Wernicke → always give thiamine before glucose to avoid precipitation.

•    Red flags in headache → prompt imaging to exclude mass, SAH, infection.

•    NPH triad clue → "wet, wobbly, wacky."