Vascular Neurology
Astra Clinical Library
Neurology
Practical neurology guides for clinical decisions, with cited evidence, testing strategies, and actionable next steps.
48 guides
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Neurology and Neurocritical Care
Status Epilepticus
Status epilepticus requires immediate seizure termination, cardiorespiratory support, etiologic evaluation, and EEG-guided escalation. Adequate early benzodiazepine dosing and prompt loading with a second-line antiseizure medication reduce avoidable progression to refractory status, while persistent impaired consciousness mandates assessment for nonconvulsive seizures.Neurology, Neurosurgery, Neuro-oncology
Conus and Cauda Equina Tumors
Conus and cauda equina tumors require urgent localization when sphincter dysfunction or progressive deficits occur, contrast-enhanced MRI for compartment-based differential diagnosis, and early multidisciplinary planning to balance neural preservation, tissue diagnosis, resection extent, stability, and oncologic prognosis.Neurology and Neurocritical Care
Subarachnoid Hemorrhage
Spontaneous subarachnoid hemorrhage requires immediate noncontrast CT, escalation to lumbar puncture when suspicion persists after negative imaging, identification and early exclusion of an aneurysm, specialized neurovascular care, and prevention of delayed cerebral ischemia with nimodipine and vigilant vasospasm surveillance. [7]Neurology and Neurocritical Care
Intracranial Hemorrhage
Intracranial hemorrhage requires immediate localization, cause-directed imaging, reversal of anticoagulation when present, and early neurosurgical or neurocritical care triage. Outcomes depend on hemorrhage compartment, hematoma expansion, ventricular involvement, hydrocephalus, blood pressure, and timely control of secondary injury.Neurology
Guillain-Barré Syndrome
Guillain-Barré syndrome is an acute immune-mediated polyradiculoneuropathy requiring prompt recognition of progressive weakness, areflexia, cranial or autonomic involvement, and respiratory risk. Diagnosis is clinical, supported by cerebrospinal fluid and electrodiagnostic testing; IVIG or plasma exchange plus intensive supportive care are established treatments.Neurology
Acute Stroke
Acute stroke care hinges on immediate hemorrhage exclusion, rapid identification of disabling ischemia and large-vessel occlusion, timely reperfusion when eligible, physiologic stabilization, and early stroke-unit management. Contemporary guidelines emphasize systems that shorten treatment delays and extend thrombectomy to selected late-window patients.Neurology and Infectious Diseases
Herpes Simplex Encephalitis
Herpes simplex encephalitis requires immediate recognition and IV acyclovir while cerebrospinal fluid HSV PCR establishes the diagnosis. Renal-adjusted dosing, hydration, and surveillance for virologic versus autoimmune relapse are the highest-yield management decisions supported by the available evidence.Emergency Medicine and Neurology
Acute Headache
Acute headache evaluation hinges on recognizing secondary causes before treating presumed primary headache. Sudden onset and abnormal neurologic examination are especially predictive red flags; persistent concern for subarachnoid hemorrhage after nondiagnostic CT warrants further evaluation, commonly lumbar puncture.Neurology
Central Post-Stroke Pain Syndrome
Central post-stroke pain is a diagnosis of lesion-concordant central neuropathic pain after stroke. Confirm the sensory phenotype and lesion, exclude common peripheral and musculoskeletal post-stroke pain generators, then individualize medication trials and consider neuromodulation for refractory disability.Neurology
Alzheimer Disease
Evaluate cognitive impairment clinically, establish or exclude Alzheimer pathology with validated amyloid and tau biomarkers when results will alter management, treat symptoms selectively, and refer eligible early-stage patients for anti-amyloid treatment assessment with MRI-based ARIA surveillance.Neurology
Parkinson Disease
Parkinson disease is a clinical diagnosis requiring bradykinesia plus rest tremor or rigidity. Confirm the parkinsonian syndrome, identify exclusion criteria and atypical red flags, use dopaminergic response as longitudinal diagnostic evidence, and individualize symptomatic therapy while actively screening motor and nonmotor disability.Neurology
Atypical Parkinsonism
Evaluate progressive parkinsonism for early autonomic failure, vertical gaze dysfunction, falls, cortical deficits, cognitive fluctuation, or poor levodopa response to distinguish multiple system atrophy, progressive supranuclear palsy, corticobasal syndrome, and dementia with Lewy bodies from Parkinson disease.Neurology
Stroke Reperfusion Injury
Recognize reperfusion injury after thrombolysis or thrombectomy by separating hemorrhagic transformation, malignant edema, and procedural complications; use serial neurologic examinations and urgent brain imaging to identify deterioration requiring blood pressure reassessment, intensive monitoring, and neurosurgical intervention.Neurology
Myasthenia Gravis
Myasthenia gravis requires rapid separation of respiratory or bulbar deterioration from stable ocular or generalized disease, confirmation with antibody and electrodiagnostic testing, chest imaging for thymoma, and phenotype-directed escalation from pyridostigmine to immunotherapy or rescue treatment.Neurology
Absence Seizure
Confirm typical absence seizures with an event-capturing EEG, then classify childhood versus juvenile absence epilepsy and screen for myoclonic or generalized tonic-clonic seizures before selecting ethosuximide, valproate, or lamotrigine.Neurology
Brainstem Stroke
Brainstem stroke requires immediate vascular imaging and reperfusion assessment because minor-appearing cranial nerve, gait, or consciousness findings may represent basilar occlusion, vertebral dissection, or perforator infarction with rapid respiratory, motor, and consciousness deterioration.Neurology
Generalized Tonic-Clonic Seizure
Manage an ongoing convulsion as status epilepticus at 5 minutes while establishing airway protection and reversible causes. After stabilization, distinguish generalized-onset epilepsy from focal-to-bilateral tonic-clonic seizure, acute symptomatic seizure, convulsive syncope, and eclampsia to guide EEG, imaging, recurrence counseling, and antiseizure therapy.Neurology
Lacunar Stroke
Manage suspected lacunar stroke as an acute ischemic stroke while confirming the mechanism with diffusion MRI and vascular-cardioembolic evaluation. Long-term decisions hinge on distinguishing true small-vessel disease from parent-artery, embolic, or incidental infarction and avoiding harmful chronic dual antiplatelet therapy.Neurology
Multiple Sclerosis
Diagnose multiple sclerosis by demonstrating typical dissemination and excluding mimics, treat clinically meaningful relapses promptly, and initiate disease-modifying therapy early while matching efficacy, safety, reproductive plans, and inflammatory activity.Neurology
Seizure
Manage a suspected seizure by identifying ongoing status epilepticus, rapidly separating acute provoked from unprovoked events, obtaining targeted metabolic, infectious, toxicologic, EEG, and neuroimaging data, and using recurrence-risk features to decide whether long-term antiseizure treatment is justified.Neurology
Stroke Mimics
Acute focal deficits require parallel stroke treatment readiness and rapid mimic recognition. Use bedside pattern analysis, glucose testing, CT-based vascular imaging, and selectively MRI or EEG to identify seizure, migraine, metabolic, functional, vestibular, inflammatory, venous, and structural alternatives without delaying reperfusion decisions.Neurology
Migraine Headache
Diagnose migraine clinically while screening for secondary headache and medication overuse; treat attacks early, select prevention by monthly migraine burden and comorbidity, and use parenteral evidence-based regimens for refractory emergency presentations.Neurology
Cluster Headache
Recognize the cluster phenotype promptly, exclude a structural trigeminal autonomic cephalalgia mimic with neuroimaging, abort attacks with oxygen or a triptan, and rapidly add transitional and preventive therapy to suppress recurrent attacks during an active bout.Neurology and Neurocritical Care
Intracranial Hypertension
Intracranial hypertension requires rapid separation of mass effect, hydrocephalus, hemorrhage, venous thrombosis, and idiopathic disease; management prioritizes herniation prevention, cerebral perfusion, etiologic imaging, and vision-preserving intervention when papilledema or progressive visual loss is present.Neurology
Medication-Overuse Headache
Medication-overuse headache requires recognition of class-specific acute-medication thresholds, exclusion of alternative secondary headache causes, and a planned withdrawal strategy. Most patients stop nonopioid acute agents abruptly while migraine prevention and close follow-up address withdrawal symptoms, persistent migraine, and relapse risk.Neurology
Tension-Type Headache
Diagnose tension-type headache clinically after screening for secondary-headache red flags, distinguish episodic from chronic disease by monthly headache frequency, limit acute analgesic exposure, and reserve preventive strategies for chronic burden or recurrent treatment failure.Emergency Medicine and Neurology
Thunderclap Headache
Thunderclap headache requires urgent exclusion of subarachnoid hemorrhage and targeted evaluation for vascular, hemorrhagic, venous, pituitary, and pressure-related disorders. Recurrent attacks, triggers, examination, cerebrospinal fluid, and vascular imaging direct evaluation toward reversible cerebral vasoconstriction syndrome or competing secondary causes.Neurology and Spine Surgery
Cervical Degenerative Disc Disease
Manage cervical degenerative disc disease by separating axial pain, radiculopathy, and degenerative cervical myelopathy; obtain MRI when neural compression is suspected; and expedite spine referral for gait, hand-function, or progressive neurologic deficits.Neurology
Charcot-Marie-Tooth Disease
Evaluate suspected Charcot-Marie-Tooth disease with phenotype, nerve conduction studies, and sequential genetic testing; distinguish uniform inherited demyelination from acquired neuropathy and pressure-palsy phenotypes, then initiate early rehabilitation, orthotic, orthopedic, genetic, and complication-directed care.Neurology
Huntington Disease
Confirm Huntington disease with targeted HTT CAG-repeat testing in the appropriate clinical context, distinguish phenocopies and secondary chorea, deliver structured predictive counseling, and target chorea, psychiatric disease, function, nutrition, and family planning through multidisciplinary care.Neurology
Posterior Reversible Encephalopathy Syndrome
Recognize PRES as an acute clinicoradiologic syndrome requiring urgent MRI confirmation, blood-pressure and seizure control, and rapid reversal of hypertension, eclampsia, renal dysfunction, or drug-related endothelial injury.Neurocritical Care
Diffuse Axonal Injury
Diffuse axonal injury should be suspected when impaired consciousness is disproportionate to CT findings after rotational head trauma. Management prioritizes severe TBI stabilization, detection of occult hemorrhagic axonal lesions with MRI, intracranial-pressure control, cautious prognostication, and early rehabilitation planning.Emergency Medicine and Neurocritical Care
Traumatic Brain Injury
Traumatic brain injury management hinges on early prevention of hypoxia and hypotension, CT-defined lesion recognition, timely neurosurgical escalation, and structured surveillance for intracranial hypertension and delayed functional sequelae.Neurology
Transient Ischemic Attack Evaluation
Treat suspected transient ischemic attack as a time-sensitive cerebrovascular emergency: establish whether infarction or a high-risk mechanism is present, complete brain, vascular, and cardiac evaluation promptly, initiate mechanism-appropriate prevention, and reserve discharge for patients with a completed expedited pathway.Neurology and Neurocritical Care
ICH Blood Pressure Management
In acute spontaneous intracerebral hemorrhage, rapidly achieve smooth systolic blood pressure control near 140 mm Hg while avoiding overshoot hypotension, marked variability, and delays during the early hematoma-expansion window.Neurology and Neurocritical Care
Anticoagulant Reversal in Intracerebral Hemorrhage
Treat anticoagulant-associated intracerebral hemorrhage as a time-critical hematoma-expansion emergency: identify the agent and last dose, send agent-relevant assays without delaying treatment, administer targeted reversal promptly, and coordinate blood-pressure management, repeat imaging, and neurosurgical assessment.Emergency Medicine and Neurology
Acute Headache Imaging
Urgent neuroimaging is indicated when acute headache has thunderclap onset, focal deficits, altered consciousness, fever, papilledema, pregnancy or puerperium, cancer, immunosuppression, coagulopathy, trauma, or a progressive new pattern. Test selection should follow the suspected vascular, infectious, pressure-related, or sellar emergency.Emergency Medicine and Neurology
Subarachnoid Hemorrhage Diagnostic Testing
Evaluate suspected subarachnoid hemorrhage with immediate noncontrast CT, using headache timing and CT interpretation quality to determine whether lumbar puncture, CT angiography, or vascular imaging is still required.Neurology
First Seizure Workup
Evaluate a first adult seizure by first excluding ongoing neurologic, toxic-metabolic, infectious, cardiac, and structural emergencies; then use eyewitness semiology, ECG, targeted laboratory testing, early EEG, and epilepsy-protocol MRI to classify recurrence risk and determine whether antiseizure treatment is justified.Neurology and Critical Care Medicine
Guillain-Barré Respiratory Monitoring
Guillain-Barré syndrome can progress rapidly to ventilatory failure despite modest limb weakness. Use serial bedside respiratory mechanics, bulbar assessment, and autonomic monitoring to identify patients needing ICU transfer and elective intubation before secretion failure, hypercapnia, or emergency airway loss.Neurology and Critical Care Medicine
Myasthenic Crisis Treatment Selection
Select plasma exchange or IVIG immediately for crisis or imminent respiratory and bulbar failure, while securing the airway, treating precipitants, and sequencing corticosteroids to avoid early worsening. Choice depends on physiologic urgency, access, contraindications, prior response, and complications.Emergency Medicine and Neurology
Spinal Cord Compression
Urgent spinal imaging and parallel management preserve neurologic function when cord or cauda equina compression is suspected. This guide distinguishes malignant, traumatic, infectious, degenerative, and neuraxial causes; selects MRI versus CT myelography; and directs immediate decompression, corticosteroid, radiation, and surgical escalation.Emergency Medicine and Neurology
Acute Vertigo Evaluation
Evaluate acute vertigo by syndrome and examination target, not symptom quality. In continuous vestibular symptoms with spontaneous nystagmus, trained HINTS-plus examination can identify central patterns that warrant stroke imaging and management despite an early negative MRI.Neurology
Acute Ischemic Stroke Reperfusion Selection
Select reperfusion therapy by rapidly separating hemorrhage from ischemia, identifying treatable large-vessel occlusion, estimating infarct extent, and applying time- and tissue-based criteria without delaying intravenous thrombolysis or thrombectomy when indicated.Neurology and Emergency Medicine
Status Epilepticus Treatment Sequence
Treat convulsive status epilepticus as a timed emergency: stabilize immediately, give benzodiazepine therapy promptly, load one second-line antiseizure medication if seizures persist, and escalate to ICU anesthetic management with EEG guidance for refractory or nonconvulsive status epilepticus.Vascular Neurology
Carotid Artery Stenosis
Manage carotid stenosis by first establishing whether a recent ipsilateral retinal or cerebral ischemic event is attributable to the lesion, confirming NASCET-equivalent severity, initiating intensive vascular prevention, and rapidly selecting endarterectomy or stenting only when procedural benefit exceeds risk.Endocrinology and Neurosurgery