Neurology can seem challenging due to its complexity. However, for those studying for the FRCEM, it is an important part of emergency medicine. You will frequently encounter questions related to identifying significant symptoms, analyzing scans, and handling urgent neurological emergencies.


Common Topics in FRCEM SBA

Anticipate that the neurology-related SBAs will encompass: 

Stroke or transient ischemic attack (TIA) 

Status epilepticus Meningitis, and encephalitis 

Guillain-Barré syndrome 

Myasthenia gravis 

Headache disorders (including migraine, cluster headaches, and subarachnoid hemorrhage), Elevated intracranial pressure or space-occupying lesions


Emergency Neurology — Key Red Flags


In the ED, always act fast if patients present with:

  • Sudden severe “thunderclap” headache
  • New focal weakness or facial droop
  • First seizure (especially age >25)
  • Fever with confusion
  • Vision loss or double vision


These symptoms could indicate stroke, Meningitis, or subarachnoid hemorrhage — all emergencies requiring quick assessment and imaging.


For a broader look at acute care priorities, see Trauma Management – Curriculum-Based Approach.


Stroke and Seizure Management


Ischemic Stroke

  • Follow FAST → CT Brain within minutes
  • Give Alteplase if within 4.5 hours and no contraindications
  • If not thrombolysed → Aspirin 300 mg stat
  • Refer to the stroke team early


Status Epilepticus


  • 1st line: IV Lorazepam
  • 2nd line: IV Phenytoin or Levetiracetam
  • Protect the airway and check glucose


CNS Infections


Meningitis

Classic signs include fever, photophobia, and neck stiffness.

 Start Ceftriaxone ± Amoxicillin immediately — don’t wait for imaging if the patient is unwell.


Encephalitis

If you suspect viral (especially HSV), start IV Acyclovir straight away.

 For detailed guidance, visit the RCEM Meningitis and Sepsis Guidelines.


Headache Disorders


  • Migraine: Throbbing, often one-sided, with light sensitivity or nausea.
  • Cluster Headache: Severe around one eye; may cause tearing or nasal blockage.
  • Tension Headache: Dull, pressure-like pain on both sides.
  • Subarachnoid Hemorrhage: Sudden, “worst-ever” headache — urgent CT required.


Neuromuscular Highlights


  • Guillain-Barré Syndrome: Ascending weakness after infection; absent reflexes.
  • Myasthenia Gravis: Fluctuating weakness, ptosis, and double vision.
  • Parkinson’s Disease: Tremor, stiffness, and slow movement.


Pediatric Neurology


Febrile seizures are common under age five. Always consider non-accidental injury if the story doesn’t fit the findings.


Quick SBA Practice


Q: A 65-year-old develops right-sided weakness and aphasia; CT shows no bleed.

A: Give IV Alteplase if within the thrombolysis window.

Q: A young adult has fever, confusion, and photophobia.

A: Start empirical antibiotics — treat as Meningitis.


Final Thoughts


Neurology questions in FRCEM focus on recognition, investigation, and emergency management. Keep revising common presentations, practise SBA reasoning, and build confidence through real-life scenarios.