Acute neurology encompasses all
those neurological illnesses that
are severe enough to warrant
urgent admission to hospital.
• 2 goals
• ABC principles
• History :
– Time of onset
– Last time seen normal
• Physical examination :
– Mental status
– Cranial nerves
– Motor
• Imaging : non-contrast
CT
• Labs
– ALWAYS look for
hypoglycemia
• CSF
– Lumbar puncture
ACUTE ISCHEMIC STROKE
maximize perfusion to limit infarction
• Lowering the head of the bed
• IV normal saline
• Permissive hypertension
• Do NOT treat hypertension unless
>220/110 mmHg or end-organ
dysfunction
• IV tissue plasminogen activator (tPA)
• Intra-arterial therapy
• Glucose control and fever control
ACUTE HEMORRHAGIC STROKE
• Prevent hematoma expansion
• Treat hypertension
– SBP < 140 mmHg
– IV Drugs : nicardipine, labetalol
• Correct coagulopathy FAST!
– Goal INR < 1.4, platelets > 100k
– PCC, Vitamin K, fresh frozen plasma
SUBARACHNOID HEMORRHAGE
“the worst headache of my life”
• Rapid diagnosis:
– Non-contrast CT
– CT angiography
– CSF :
• LP : Gross blood
• Xanthochromia
• Notify neurosurgery
• Prevent rebleeding
• Treat hypertension
• Antifibrinolytics
STATUS EPILEPTICUS
 Any single seizure lasting > 5min
 ≥ 2 seizures without clearing of mental status between them
• Abort the seizure
– Lorazepam
• Prevent future seizures
– Phenytoin load
NERUOMUSCULAR DISEASE
• Diagnosis:
– serum autoantibody testing
– electromyography
– nerve conduction studies
Myasthenia gravis
Control breathing before catastrophe!
• Intubation and
mechanical ventilation
• Intravenous
immunoglobulin
• Plasmapheresis
MENINGITIS
• Rapid diagnosis
–
–
–
–
History
EXAM!
CSF
Labs
Within TWO hours:
• Dexamethasone
• Antibiotics
• Vancomycin, Ceftriaxone
• Ampicillin
References
•
•
•
•
Neurologic emergencies,Joseph D. Burns, M.D.
http://emj.bmj.com/content/22/6/440.full
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2885257/
https://academic.oup.com/brain/article/127/5/1213/303021/NEUR
OLOGIC-EMERGENCIES-A-SYMPTOM-ORIENTED-APPROACH
• http://www.mdedge.com/ccjm/article/106010/criticalcare/common-neurologic-emergencies-nonneurologists-whenminutes-count/page/0/1
• https://www.apollohospitals.com/patient-care/health-andlifestyle/diseases-and-conditions/common-neurologicalemergencies
• http://www.mayoclinic.org/diseases-conditions/stroke/symptomscauses/dxc-20117265
Care shouldn't start in the emergency room.
James Douglas