Neurology

Craniofacial pain

Blurb needed

Last updated: 3/20/2026

Headache in Pregnancy

Blurb needed

Last updated: 3/20/2026

Idiopathic Intracranial Hypertension

IIH is a disorder related to increased intracranial pressure of unknown cause, primarily affecting women of childbearing age (20–50) with a body max index >30.

Last updated: 3/27/2026

New Onset Headache

The majority of individuals presenting with a new headache will likely be diagnosed with a benign headache, however, in a minority a potentially serious etiology may be identified. A systematic approach to headache history and knowledge of the signs and symptoms suggestive of a secondary cause for headache is essential.

Last updated: 3/27/2026

Movement Disorders

Abnormal Movements in the In-patient Setting

History taking should include characterization of the movement(s) phenomenology, including distribution, rhythmicity, onset, progression, exacerbating or alleviating factors, and neurologic symptoms or conditions. History should be obtained from the patient, medical providers, nursing staff, and collateral sources in close contact with the patient when available. An important distinction is whether the abnormal movements: (1) were present prior to hospitalization, (2) were part of the presenting complaint, or (3) developed during hospitalization. Abnormal movements present prior to the hospitalization may suggest a previously undiagnosed movement disorder or neurologic condition. In contrast, Aabnormal movements that develop during the hospitalization are most commonly due to metabolic derangements, toxic exposures, medication related effects, or acute neurologic injury.

Last updated: 6/20/2026

Movement Disorders

Parkinsonism

Parkinsonism is deﬁned as bradykinesia in combination with either rest tremor, rigidity, or both. Parkinson’s Disease is the most common cause of parkinsonism and remains a clinical diagnosis that relies on history and supportive exam findings. Additional etiologies of parkinsonism include drug and toxin-induced, vascular, and other neurodegenerative conditions. A diagnosis of Parkinson’s Disease requires at least 2 cardinal motor manifestations and exclusion of other etiologies.

Last updated: 5/24/2026

Neuro-inflammatory

MS Relapse

MS is a demyelinating disease process. An MS relapse will have corresponding enhancing lesions on MRI. A pseudo-relapse will not show any new lesions on MRI. If it is a pseudo-relapse, treat the underlying cause (e.g. infection). If it is an MS relapse, treat with steroids, and if severe, IVIG/PLEX. Other demylinating diseases to keep on your differential are NMO, MOG, CNS Sjogren's, and toxic, inflammatory and metabolic disorders.

Last updated: 3/27/2026

Neuro-inflammatory

Optic Neuritis

Inflammation of the optic nerve is a commonly associated with multiple sclerosis (as a presenting symptom or during the course of the disease), however, many other conditions may cause optic nerve dysfunction which can often be elicited through a comprehensive history.

Last updated: 3/27/2026

Neuromuscular

Acute onset or rapidly progressive weakness

History taking should focus on identifying the extent of weakness, presence or absence of other neurologic symptoms, temporal progression of symptoms, identification of antecedent triggers, and associated conditions. Weakness secondary to primary brain conditions are not included in this template.

Last updated: 6/20/2026

Inability to wean from ventilator in ICU setting

Neuromuscular cause for respiratory weakness should be considered in a patient whose mental status does not preclude extubation and other contributing conditions (pulmonary, cardiac, etc.) have been excluded. Diaphragmatic weakness resulting in the inability to wean a patient from mechanical ventilation may be due to a previously undiagnosed or subclinical neuromuscular condition or due to hospitalization or iatrogenic causes, with ICU acquired diaphragmatic weakness remaining a common etiology in the in-patient setting. History taking should include inquiring about symptoms of neuromuscular weakness prior to hospitalization to suggest a primary neurologic cause. History from the patient is often limited given the patient’s intubated state and therefore obtaining collateral history from individuals in close contact with the patient Neuromuscular cause for respiratory weakness should be considered in a patient whose mental status does not preclude extubation and other contributing conditions (pulmonary, cardiac, etc.) have been excluded. Diaphragmatic weakness resulting in the inability to wean a patient from mechanical ventilation may be due to a previously undiagnosed or subclinical neuromuscular condition or due to hospitalization or iatrogenic causes, with ICU acquired diaphragmatic weakness remaining a common etiology in the in-patient setting. History taking should include inquiring about symptoms of neuromuscular weakness prior to hospitalization to suggest a primary neurologic cause. History from the patient is often limited given the patient’s intubated state and therefore obtaining collateral history from individuals in close contact with the patient is crucial.

Last updated: 6/20/2026

Myasthenia Gravis (Post-Operative Assessment)

Worsening of symptoms of myasthenia gravis Is a known potential complication following surgery. History should focus on understanding baseline deficits (if present) and identifying new or worsening post-op deficits, in conjunction with the neurologic exam and ancillary studies such as respiratory parameters.

Last updated: 5/24/2026

Myasthenia Gravis (suspected diagnosis or established diagnosis)

Myasthenia gravis is a chronic autoimmune neuromuscular disorder with a bimodal age distribution classified as early onset (age 20s-30s, women > men and late-onset (age 60s-80s men > female). Symptoms may seem relatively non-specific. A history of fatiguing/fluctuating weakness involving preferentially affected muscle groups adds to diagnostic certainty.

Last updated: 3/22/2026

Rapidly Progressing Weakness

If a patient has acute onset upper and/or lower extremity weakness (7 days or less), do not miss structural cord compression as this is a neurologic emergency. Obtain STAT MRI of the entire spine without contrast. If there is a history of cancer, obtain the MRI with and without contrast to evaluate for epidural mets. If weakness is hyperacute, get MRI with DWI to assess for spinal cord ischemia. If weakness is <48h, also get CTH and CTA head/neck to rule out basilar artery occlusion. If they are diffusely areflexic/hyporeflexic, also do an LP to evaluate for AIDP. You will also need to order telemetry, NIF/FVC q4h, and start IVIG ideally after serum studies collected unless contraindications.

Last updated: 1/30/2026

Seizure/Syncope/Dizziness

Acute Onset Dizziness

Utilizing a timing and triggers approach to acute onset dizziness often identifies an underlying etiology for the patient’s presentation.

Last updated: 6/20/2026

First Time Seizure

The approach to a first time seizure is to first obtain a thorough description of the episode. This will help you differentiate a nonepileptic seizure from an epileptic one. Then, assess for possible triggers for the episode and whether the patient has had any unrecognized seizures in the past. After a first time seizure, an EEG and MRI seizure protocol should be performed to assess the patient’s risk for a recurrent seizure. If these are normal, the chance for a second seizure is ~30% and AEDs are typically not recommended.

Last updated: 3/20/2026

Known Epilepsy with Breakthrough Seizure

The approach to a breakthrough seizure is to first characterize the episode and determine what the precipitating factor was. This will help guide treatment. If it is due to medication non-compliance, patients are restarted on their home meds +/- a loading dose.

Last updated: 3/20/2026

Orthostatic Hypotension/Autonomic Dysfunction

Orthostatic hypotension (OH) is defined as a fall in blood pressure (>20 mm Hg fall in systolic BP OR >10 mm Hg fall in diastolic BP) that occurs within three minutes of standing up from a lying or seated position. Through history taking and vitals assessment, OH should be classified as neurogenic and/or non-neurogenic, with specific etiologies identified. Neurogenic orthostatic hypotension is caused by dysfunction of the baroreceptor reflex. Non-neurogenic causes for orthostatic hypotension are more common and are a result of external reversible factors that impair normal hemodynamic compensation.

Last updated: 5/27/2026

Seizure vs Syncope

It can be difficult to differentiate seizures from syncope, but directed questions involving the semiology of the episode and associated symptoms can help differentiate the two.

Last updated: 3/20/2026