Neurologists are often called to the emergency department to evaluate various acute primary central and peripheral nervous system disorders or neurological complications of multiple systemic illnesses. In these situations, prompt diagnosis can be lifesaving. Examples abound, but basilar thrombosis, aneurysmal subarachnoid hemorrhage, bacterial meningitis, and Guillain–Barre syndrome are just some illustrations. But the job of the neurologist is no longer restricted to being the master diagnostician. During the last three decades and with introduction of modern treatments, such as tissue plasminogen activator for treatment of acute ischemic stroke and the development of vascular interventional procedures, much can be offered to patients with acute neurological diseases in the emergency department.

This article provides a comprehensive overview of the management of patients with coma. The article begins with a discussion of the emergency management of patients presenting with an acute alteration in the level of consciousness. It then reviews concepts on supportive care that are necessary to reduce secondary neurologic injury. A third section addresses management according to the underlying cause of coma, with emphasis on diagnoses that are frequently encountered. Issues related to the long-term management of patients in coma and outcome prediction are briefly discussed.

Seizures and status epilepticus are epilepsy emergencies with high morbidity and mortality. Early treatment is crucial, and the identification of an underlying etiology informs both continued treatment and prognosis. Many patients have underdiagnosed nonconvulsive seizures or nonconvulsive status epilepticus, particularly the comatose or critically ill. Timely EEG can be useful for diagnosis, management, optimizing treatment response, and determining prognosis in these patients. Refractory conditions can be quite complicated with limited evidence-based guidance, but treatment should not be restricted by nihilism even in the most prolonged cases, especially if there is not widespread irreversible brain injury.

Headaches are a common reason for visiting a health care provider. Headaches are at times symptomatic of an underlying process that requires prompt diagnosis and urgent treatment to reduce threats to life or limb. In this article, the authors review the 6 most common presentations for worrisome headache and discuss the differential diagnosis. Careful attention to patients’ history and physical examination and a thoughtful approach to the differential diagnosis will guide diagnostic work-up and management. Although benign causes of headache are much more common than malignant secondary processes, thorough management of the acute headache requires excluding malignant secondary processes.

The cause of dizziness in patients seen in the emergency room can usually be determined by a focused evaluation that consists of identifying three key features in the history and five key elements of the clinical examination. This article discusses the most common causes of dizziness, how to use this approach, and management of these cases in the emergency room.

Patients with neuro-ophthalmologic findings and diseases commonly present in the emergency room. This article reviews the approach to acute visual loss, the abnormal optic disc, double vision, and the neuro-ophthalmologic signs of neurologic emergencies, including hydrocephalus, herniation syndromes, vascular lesions, and trauma.

The nervous system can be significantly affected by cancer. Neurologic symptoms are present in 30% to 50% of oncologic patients presenting to the emergency department or in neurologic consultation at teaching hospitals. Evaluation and treatment require collaborative effort between specialties. The causes of neurologic emergencies in patients with cancer are mostly related to effects of cancer, toxicities of treatments, infections, and paraneoplastic syndromes. These complications cause significant morbidity and mortality and require prompt and accurate diagnostic and treatment measures. This article reviews the common neurologic emergencies affecting patients with cancer and discusses epidemiology, clinical presentation, diagnosis, and treatment modalities.

Nearly 70 years after the discovery of penicillin, neurologic infectious diseases (NIDs) remain an important worldwide source of morbidity and mortality. The clinician faced with a potential NID must urgently consider patient demographics, pace of illness and clinical syndrome, and laboratory data. In keeping with the topics of this issue, initial emergency diagnosis and management are emphasized, with appropriate references to relevant literature for subsequent longer-term interventions.

Respiratory failure could result from a cardiopulmonary or a primary neurological disease. The latter could happen as a result of involvement of the central nervous system or a neuromuscular disease. Different neuromuscular diseases could result in respiratory failure by causing significant weakness of the respiratory and upper airways muscles. When confronted with a patient who presents with respiratory failure, the first task of the clinician is to secure the airways and stabilize the hemodynamic condition. The next step is the diagnostic approach and potentially a disease specific treatment, which is the focus of this review.

The past 40 years have seen the evolution of acute ischemic stroke management from unproven therapies du jour, such as steroids, heparin for stroke in evolution, and hypervolemic-hemodilution, to more of a scientific basis for our decision-making process. This evolution is directly related to the advancements in imaging of stroke. It is also related to carefully designed, controlled clinical trials of potential therapies, which have led to the recognition of the benefits of thrombolytic therapy in the acute setting but have also caused confusion and frustration over the lack of benefit for potential neuroprotective agents that once seemed promising.

Intracranial hemorrhage (ICH) is defined as bleeding within the intracranial vault and has several subtypes depending on the anatomic location of bleeding. ICH is diagnosed through history, physical examination, and, most commonly, noncontrast CT examination of the brain, which discloses the anatomic bleeding location. Trauma is a common cause. In the absence of trauma, spontaneous intraparenchymal hemorrhage is a common cause associated with hypertension when found in the deep locations such as the basal ganglia, pons, or caudate nucleus. This article addresses the diagnosis and general management of ICH and discusses specialized management for select ICH subtypes.

This article reviews aspects of management of traumatic brain and spinal cord injury. A discussion of management of intracranial pressure after traumatic brain injury is followed by a discourse on cerebrovascular trauma and pediatric injuries. Specific management methods are discussed, including medical and surgical management in intracranial hypertension. A special attempt is made to include the current recommendations for management of brain and spinal cord injuries. Spinal cord injuries are discussed in the final section. With an increasing number of patients surviving after devastating spinal cord injuries, the special issues in their management are evaluated.

Neurologic effects of acute drug intoxication are varied. This article discusses the acute neurologic effects of certain drugs as well as associated treatments and guidelines to management.

Central nervous system (CNS) inflammatory demyelinating diseases are a group of disorders that include multiple sclerosis, acute disseminated encephalomyelitis, and neuromyelitis optica. These conditions may result in emergencies because of severe inflammatory destruction of CNS tissues or complications thereof. Most of these conditions are responsive to appropriate therapy and early diagnosis and treatment leads to better outcomes. We discuss the spectrum of emergencies associated with these disorders, as well as clinical features, investigations, and management.

Movement disorders uncommonly require emergent intervention; however, there are acute/subacute clinical settings in which the neurologist is consulted for recommendations about the diagnosis and management of a movement disorder. In these circumstances the neurologist must be comfortable with the diagnostic evaluation and be prepared to properly manage the patient. This article focuses on diagnosis and management of acute-onset movement disorders occurring secondary to prescription drug use, illicit drug abuse, and drug withdrawal syndromes. In addition, drug-induced emergencies occurring in patients with movement disorders are reviewed.

In the emergency department, neurologists regularly evaluate patients exhibiting behavioral abnormalities that stem from underlying neurologic diseases. This behavior may be the initial presence of a neurologic illness or may indicate the deterioration and progress of the disease process. In addition, many neurologic patients present with acute and potentially dangerous psychiatric symptoms that demand rapid and accurate management. Assessment, diagnosis, and treatment of patients with psychiatric manifestations in the context of neurologic illness pose a significant challenge to treating neurologists. This article discusses a general approach to assessment and treatment of some of the more common psychiatric disorders.

During the past 2 decades, the world has witnessed a significant improvement in the understanding of the pathogenesis and treatment of neurologic diseases, which presents emergencies. Every day neurologists are consulted for patients who present with neurologic emergencies to the emergency departments. In this article, we present a series of case reports about patients with acute neurologic and psychiatric problems and discuss their management briefly.

The prognosis of patients with altered consciousness is mainly determined by early diagnosis and appropriate therapeutic interventions and by the type of toxin. The potential causes of altered consciousness are many and may reflect systemic illness, isolated organ system dysfunction, drug intoxications or withdrawal, psychiatric illness, or neurologic disease. In this article, a comprehensive approach to patients with altered consciousness and suspected poisoning is discussed. This survey, however, does not intend to be a substitute for the need for consultation with a clinical toxicologist qualified in the diagnosis and treatment of poisoned patients.