1. EM2 NEUROLOGICAL EMERGENCIES
Required Readings:
Tintinalli Chapters 220, 224, 225
1. Identify the two types of stroke and the percentage of occurrence of each type.
2. For ischemic strokes, identify or describe the following:
a. What happens in a thrombotic stroke
b. The most common cause of thrombotic strokes
c. Signs & symptoms of a thrombotic stroke
d. The relationship between thrombotic strokes and TIAs
e. The percentage of strokes that are embolic
f. Common sources of emboli
3. For hemorrhagic strokes, identify or describe the following:
a. 30-day mortality rate
b. General age of patients compared to thrombotic strokes
c. Risk factors for intracerebral hemorrhage (ICH)
d. The etiology of half of subarachnoid hemorrhages
4. Define transient ischemic attack (TIA) and identify with which type of stroke they
are most associated.
5. Explain what happens with a middle cerebral artery infarct depending on whether
the left or right hemisphere is involved (In the vast majority of patients, the left
hemisphere is considered “dominant”.).
6. Describe the signs and symptoms of vertebrobasilar syndrome.
7. Explain how an intracerebral hemorrhage presents differently than a thrombotic
stroke.
8. Describe the presentation of a subarachnoid hemorrhage and explain what is meant
by a “sentinel hemorrhage”.
9. Briefly explain how to distinguish the following from a stroke:
a. Bell’s palsy
b. Hypertensive encephalopathy
c. Multiple sclerosis
10. Discuss how noncontrast CT of the head is used in early stroke diagnosis.
11. Identify when carotid duplex is used in the diagnosis of stroke.
12. Describe the initial treatment of stroke patients in the ED.

2. 13. Treatment of ischemic stroke with thrombolytic therapy remains controversial and is
still not widely used. Despite this, list the three criteria that must be met before
thrombolytic therapy is considered.
14. Briefly identify the following:
a. Epilepsy
b. Primary seizure
c. Secondary seizure
d. Reactive seizure
e. Several things that can lower the seizure threshold
15. Describe a typical generalized tonic-clonic seizure (grand mal).
16. List the 9 causes of secondary seizures from Table 224-2.
17. Identify 4 clinical features that help to distinguish seizures from other kinds of
mimicking attacks.
18. Describe certain general measures that should be taken for any seizure patient.
19. For seizures in HIV-positive patients, describe how the etiology differs from
immunocompetent patients and identify the most common mass lesion.
20. For seizures in the alcohol abuser, identify the following:
a. When alcohol withdrawal seizures typically occur
b. What class of drugs are used to treat them
21. Define status epilepticus and explain why treatment should begin as soon as
possible.
22. Identify the following regarding treatment of status epilepticus:
a. Goal of treatment
b. What causes morbidity
c. Initial labs to be evaluated
d. What should be given if hypoglycemia is a concern
e. What should be done if drug ingestion is suspected
f. What should be done in meningitis is suspected
g. The initial drug of choice
h. The longer-acting drug which should be given next
23. Identify the following signs & symptoms for:
a. sensory disorders
b. motor disorders
c. autonomic disorders

3. 24. Identify the bacterium responsible for botulism and how the disease is acquired
differently in adults and infants.
25. Identify clinical features of botulism in infants and adults.
26. Describe a frequent antecedent to the onset of Guillian-Barre syndrome (GBS) and
what is thought to cause the syndrome in most cases.
27. Explain how GBS presents, signs and symptoms, and a hallmark finding on physical
exam.
28. Briefly explain the general treatment for GBS.
29. Identify common signs and symptoms of Bell’s palsy and list several other
disorders that should be included in your differential diagnosis.
30. Discuss the treatment of Bell’s palsy regarding steroids and eye care.