Reference Cards
Guide To Neurology
Clinical Differential Diagnosis:
I) Headache Tension headache, Migraine, Cluster headache, HTN, SAH - Subarachnoid hemorrhage, Meningitis, CVA, TIA, Aneurysm, Brian tumor, Metastatic cancer, AVM, Subdural hematoma, Vasculitis (Temporal Arteritis), Post-LP, Encephalitis, Brain abscess, Trauma, Postictal, Internal carotid artery dissection, Depression, Sinusitis, Trigerminal neuralgia, Optic neuritis, Atypical facial pain, TMJ syndrome, Dental abscess, Otitis, inc Intraocular pressure (Acute closed-angle glaucoma), Eye Disorders, Cervical spine syndrome, Psychogenic, Fevr, Hypoglycemia, Hypoxia, Hyperthyroidism, Drugs or Toxins, (Nitrates or other vasodilators, Alcohol - ? withdrawl, MSG, Nitrites, CO), Pheochromocytoma, Pseudotumor cerebri, Lyme disease, Altitude sickness.
CT Indications: mental status change, observable deterioriation, focal deficit, new seizures, meningeal signs, onset during exertion, worst HA, first severe HA, change in pattern of known HA.
II) Dementia Alzheimer's, Cerebrovascular/Multi-infarct, Hydrocephalus, Senile, Parkinson's, Alcohol (Wernicke/Korsakoff), Hypoxia, Hypoglycemia, MS (Demyelinating), Post-traumatic (chronic subdural hematoma-headache, hemiparesis, 50-70, alcohol, cerebral atrophy, anticoagulant, hemodialysis), ALS, Drug Toxicity (Tranquilizers, Hypnotics, Lithium, Tricyclic antidepressants, Anticholingergics, Steroids, Anticonvulsants, Dopaminergic, Antihypertensives), Uremia, Wilson's Disease, (LFT's, Copper, Ceruloplasmin), Lead, Arsenic, Vit B12 def (macrocytic anemia), inc or dec T4, Hypo-hyperparathyroidism, PA, dec Folate, Chronic liver disease, SIADH, Dialysis, AIDS, Neurosyphilis (FTA, CSF VDRL), Progressive multifocal leukoencephalopathy, Intracranial neoplasm, Paraneoplastic syndrome, Huntington's, Pick's, Progressive supranuclear palsy, Creutzfeldt-Jakob (EEG), Depression, Psychosis.
III) Coma Intracerebral epidural or subdural hemorrhage, SAH, Intracerebral infarction, Intracranial neoplasm (primary or metastatic), Hypoglycemia, Cerebellar hemorrhage, infarct or tumor, Pontine or Brainstem Injury; Pituitary apoplexy, Encephalitis, Meningitis or Abscess; Trauma (closed head injury), Status epilepticus, Postical Hypoxia, Hypercarbia (respiratory acidosis), DKA, Hyperosmolar nonketotic coma, Hepatic encephalopathy, Uremic encephalopathy, Myxedema, Thyrotoxicosis, Adrenal Crisis, Sepsis, Hyponatremia, Hypernatremia, Hypercalcemia, Hypothermia, Heat Stroke, Carbon Monoxide, Tranquilizers, Barbituates, Opiates, Psychotropics, Methanol, Ethyl Alcohol, Paraldehyde, Ethanol, Lead, Arsenic, CN, ASA, Vasculitis, Progressive multifocal leukonecephalopathy.
IV) Pupil Position in Coma
A) Normal 3-4 mm Symmetrical Reactive to light
B) Diencephalic, (Thalamus) Small Symmetrical Reactive to light
C) Midbrain Midposition Symmetrical Fixed to light
D) Pons Pinpoint Symmetrical Reactive to light
E) Temporal LobeHerniation Unilat. Dilated (1) Asymmetrical Fixed to light
F) Anticho- linergics, Anoxia Dialated Symmetric Fixed to light
G) Opiates Pinpoint Symmetrical Reactive to light
H) Metabolic Small Symmetrical Reactive to light
 I) Hypothermia Dilated Symmetrica Fixed to light
(1)- Other causes of unilateral dilated pupil may include:aneurysm, migraine, drug-induced mydriasis, Adie's and Transient benign dialation.

V) Polyneuropathy - Alcoholism, Diabetes, (distal sensory, motor, autonomic-postural hypotension, abnormal bowel bladder sexual function), Vit B12 deficiency, inc or dec Vit B6, Folate deficiency, Thiamine deficieny, Hypothyroidism, Renal insufficiency - Uremia (symmetrical), Hepatic failure, Gullain-Barre (progressive symmetrical weakness with variable areflexias), Poliomyelitis, Diphtheria, Chronic inflammatory polyneuropathy, Paraproteinemia (Multiple myeloma), Amyloidosis, SLE, Vasculitis (Wegener's, PAN), Lyme, Sarcoidosis, Porphyria, Paraneoplastic, AIDS (distal sensory and motor), Atherosclerosis, Lead, Arsenic, Mercury, Organophosphorous cmpds, Occupational Solvent Exposure, Drug-induced (INH, Dilantin, Vincristine, Amiodarone, Hydralazine, Gold, Cisplatin), Leprosy, Genetic (Charcot-Marie-Tooth, Fabry's, Refsum's), Cryoglobulins or Acute idiopathic.
VI) Proximal Muscle Weakness Myasthenia gravis (autoimmune, voluntary muscle fatigue esp extraocular and cranial muscles, ptosis, diplopia, dysarthria, leg weakness, normal DTRs, asymetric; Dx - Edrophonium [Tensilon] Test - not with asthmatics), Polymyositis- Dermatomyositis, Muscular dystrophy, Alcoholic, MS (20-40, variable demyelination, weakness, numbness, diploplia, change in vision in one eye, gait disorder, ? transient recurring progressive symptoms), Eaton-Lambert (assoc. with CA - paraneoplastic - ? Oat Cell, or autoimmune disease, Tensilon no help), ALS, Hyperthyroidism, Cushing's syn., Hyperparathyroidism, Sacroidosis, Congenital, Electrolye disturbance (Hypokalemia), Carcinomatous myopathy, Porphyria, Diabetes (Prox. mononeuropathy), Inflammatory polyneuropathy (actue and chronic), and Glucocorticoid therapy.
VII) Acute Generalized Weakness Myasthenia Gravis (asymmetric, weakness made worse with exercise), Guilain Barre Syndrome (viral prodrome, paresthesias, ascending paralysis, symmetric, may need respiratory support, decreased DTRs), Tick Paralysis (symmetric, ascending paralysis, decreased DTRs; Rx - remove tick), Lyme Disease (B. burgdorferi via tick bite, constellation of symptoms derm - vasculitis -arthritis - neuro (asymmetric, sensory deficits, extremity and facial weakness with cranial nerve involvement, Rx - Abx), Botulism (symmetric, descending paralysis, normal DTRs, may need respiratory support), Eaton Lambert Syndrome, Psych Diagnosis, Depression, Malnutrition, Electrolyte Abnormalities (Na, K, Mg, Phos, Ca - check chemistry panel), Anemia, Polio (viral prodrome, asymmetric may need ventilator), Diptheria (can mimic GBS), Polymyositis, Drugs (chemo, B Blockers, Lithium, phenothiazines).
VIII) Vertigo Infectious labyrinthitis, Vestibular neuronitis, Meniere's disease, Benign positional vertigo, Cholesteatoma, Drug-induced (ASA, ETOH, Anticonvulsants, Aminoglycosides), Posttraumatic, Middle/Inner ear surgery with perilymph fistulas, Vertebrobasilar ischemia, Acoustic neuroma, Posterior fossa tumors, Metastatic carcinoma, Migraine, Temporal lobe epilepsy, Syphilis, Multiple sclerosis, Motion sickness and Hyperventilation.
IX) CNS Neoplastic Emergencies Spinal cord compression, Increased intracranial pressure secondary to primary brain tumor, intracerebral or meningeal metastasis; Other CNS complications may include Paraneoplastic syndrome, Radiation or drug-induced toxicity, Metabolic encephalopathy, SAH, Subdural hematoma, Intracerebral hemorrhage, Tumor embolus, Septic embolus, Nonbacterial endocarditis and Venous thrombosis.
X) Back Pain Lumbosacral strain or sprain, Intervertebral herniated disc, Vertebral fracture, Spondylosis, Osteoarthritis, Prostatic disease - Cancer - mets, Malignant disease (Primary vs. Metastatic), Shingles (H. Zoster), Sacroileitis, Spondylitis, Spinal stenosis, Vertebral osteomyelitis, Epidural abcess, Intervertebral disc space infection, AAA, Reptroperitoneal tumor or hematoma, Nephrolithiasis, Pyelonephritis, Pancreatitis, Hip disease, Pnuemonia - pleurisy, Osteoporosis, Osteomalacia, RA, Hyperparathyroidism, PUD, Angina, Muscular - Facial Syndrome, Sprina bifida, and Poor Posture.
XI) Upper Motor Neuron Lesion - Weakness, paralysis, spasticity, +Babinski, inc tendon reflexes, inc tone; Lower Motor Neuron Lesion - Weakness, paralysis, muscle atrophy/flacid, no spasticity, loss of tendon reflexes, normla plantar reflex, fasciculations.