Neurology

Neurology is a broad AKT topic covering headache, epilepsy, stroke, movement disorders, and neuropathy. Pattern recognition and red flag awareness are key.

Headache diagnosis is frequently tested. Tension-type headache is the most common: bilateral, pressing quality, mild to moderate severity. Migraine presents with unilateral pulsating headache, nausea, photophobia and phonophobia, lasting 4-72 hours. Migraine with aura (visual disturbance preceding headache by 5-60 minutes) is a contraindication to combined oral contraceptives due to stroke risk. Cluster headache is severe unilateral periorbital pain with autonomic features (lacrimation, nasal congestion, ptosis), occurring in clusters over weeks. Red flags: thunderclap headache (sudden onset, worst ever, subarachnoid haemorrhage until proven otherwise), headache with fever and neck stiffness (meningitis), headache with papilloedema (raised intracranial pressure), new headache in over-50s with scalp tenderness (giant cell arteritis).

Epilepsy management in primary care involves recognising seizure types, knowing first-line medications, and understanding when to refer. First-line for focal seizures: lamotrigine or levetiracetam. First-line for generalised tonic-clonic seizures: sodium valproate (not in women of childbearing age due to teratogenicity) or lamotrigine. First-line for absence seizures: ethosuximide or sodium valproate. Women of childbearing age must not be prescribed valproate unless no alternative exists and they are on the Pregnancy Prevention Programme. Driving restrictions: must be seizure-free for 12 months (or 12 months of seizures only during sleep if established pattern).

Stroke recognition uses the FAST mnemonic (Face, Arms, Speech, Time). Acute management is emergency referral for thrombolysis (within 4.5 hours of onset) or thrombectomy (within 6-24 hours for large vessel occlusion). Secondary prevention includes antiplatelet therapy (clopidogrel 75mg), statin, blood pressure management, and lifestyle modification. TIA requires urgent assessment within 24 hours.

Parkinson's disease presents with the classic triad: bradykinesia (mandatory for diagnosis), plus either resting tremor or rigidity. Refer to neurology for diagnosis. Do not start treatment in primary care. First-line treatment is levodopa (co-careldopa or co-beneldopa) for motor symptoms. Dopamine agonists (ropinirole, pramipexole) are alternatives, particularly in younger patients, but carry risks of impulse control disorders.

Multiple sclerosis presents with episodes of neurological dysfunction separated in time and space. Common presentations include optic neuritis (painful vision loss), transverse myelitis, and sensory symptoms. Refer to neurology for MRI and diagnosis. GPs manage ongoing symptom management and coordination of care.