Aphasia

Ischemic stroke is sudden focal neurologic deficit from arterial occlusion confirmed by infarction on neuroimaging. Diagnosis relies on urgent noncontrast head CT to exclude hemorrhage; treatment is IV alteplase within 4.5 hours and mechanical thrombectomy for large-vessel occlusion within an extended window, followed by antiplatelet therapy and risk-factor control.

Carotid artery stenosis is atherosclerotic narrowing of the extracranial internal carotid artery that raises ischemic stroke risk, graded by percent luminal narrowing on duplex ultrasound. Symptomatic stenosis of at least 50% warrants urgent revascularization; asymptomatic stenosis under 80% is managed with best medical therapy alone, including a high-intensity statin and antiplatelet agent.

Atrial fibrillation is a supraventricular tachyarrhythmia with disorganized atrial activation and an irregularly irregular ventricular response, the most common sustained arrhythmia and a major cause of stroke. Diagnosis is by ECG showing no discrete P waves with irregular RR intervals, and management addresses rate or rhythm control, stroke prevention by CHA2DS2-VASc-guided anticoagulation, and the underlying cause.

Dysphagia is difficulty swallowing, and the history alone localizes it to oropharyngeal disease, marked by choking or nasal regurgitation at the start of a swallow, or esophageal disease, marked by food sticking seconds later. Esophageal dysphagia with solids alone points to a mechanical obstruction worked up first with upper endoscopy, while dysphagia for solids and liquids together points to a motility disorder worked up with barium esophagram and manometry.

Delirium is an acute, fluctuating disturbance of attention and awareness caused by an underlying medical, toxic, or metabolic insult. Diagnosis rests on the Confusion Assessment Method; management is identification and treatment of the precipitating cause plus withdrawal of deliriogenic drugs, reserving antipsychotics for safety only.

Frontotemporal dementia (FTD) is the second most common neurodegenerative dementia in patients under 65, comprising a behavioral variant marked by early personality and disinhibition change and language variants (primary progressive aphasia) marked by isolated progressive language decline. Diagnosis rests on clinical criteria supported by MRI or FDG-PET showing frontotemporal atrophy; there is no approved disease-modifying or symptomatic drug therapy.

Epilepsy is a disease of recurrent unprovoked seizures, defined as two unprovoked seizures more than 24 hours apart or one unprovoked seizure with at least a 60% recurrence risk; treatment is guided by seizure type, with levetiracetam or lamotrigine preferred first-line for most adults.

Small subcortical infarct, under 1.5 cm, from occlusion of a single penetrating artery, most often caused by hypertensive lipohyalinosis, producing one of five classic pure motor, pure sensory, ataxic hemiparesis, dysarthria-clumsy hand, or mixed sensorimotor syndromes without cortical signs, diagnosed by MRI and managed with the standard acute stroke pathway plus aggressive antiplatelet, statin, and blood pressure secondary prevention.

Spontaneous bleeding into brain parenchyma, most often from chronic hypertension affecting deep penetrating vessels or from cerebral amyloid angiopathy in lobar locations, diagnosed by noncontrast CT and managed with acute blood pressure lowering, reversal of anticoagulation, and surgical evacuation for select cerebellar or deteriorating hemorrhages.