Neurologic Emergencies

Amal Mattu, MD, FAAEM, FACEP, Consulting Editor

If you were to ask emergency physicians which organ system they feel least comfortable managing in times of emergency, the majority are likely to mention the neurologic system. This system, and in particular the brain, has been considered the “black box” of the human body for generations. I believe that the reasons for this difficulty is fairly simple: basic science training of the neurologic system in medical school is often considered complicated, and clinical training in most medical schools in neurology is very brief compared with other areas in medicine. In addition, the neurologic system cannot be seen, felt, or auscultated. Yet, neurologic complaints and emergencies are common, and their complications are devastating. Physician discomfort and worry regarding the proper management of many neurologic conditions lead to an excess in radiologic testing and even a false sense of security when the imaging is normal.

Almost every continuing medical education conference focused on emergency medicine or risk management includes teaching sessions on neurologic emergencies. Despite this, litigation for misdiagnosed neurologic conditions such as stroke, spinal cord disorders, and intracranial hemorrhage continues to be common. We as educators clearly are not doing enough to spread the knowledge of proper diagnosis and treatment of such conditions.

I was, therefore, thrilled to welcome Drs Jonathan Edlow and Michael Abraham to serve as Guest Editors of this issue of Emergency Medicine Clinics of North America . Both of these educators have dedicated their careers to educating emergency physicians in the improved care of patients with neurologic emergencies. In this issue, they have assembled an outstanding team to discuss a wide range of conditions, from the common to the catastrophic. Common neurologic presentations are addressed, including headache, dizziness, weakness, back pain, and coma. Authors discuss how to identify red flags in the history and physical exam that can help identify the needle in the haystack of these patients. Other authors discuss cerebrovascular conditions, including transient ischemic attack and stroke, both ischemic and hemorrhagic. Status epilepticus is addressed and includes a discussion of some newer therapies. Final articles address neurologic conditions in the pregnant patient, and there is a special article on neuro-ophthalmology in emergency medicine.

The Guest Editors and authors are to be commended for their hard work. This issue of Emergency Medicine Clinics of North America represents an invaluable addition to the emergency neurology literature and should be considered required reading in the curriculum for all emergency care providers and trainees. In this issue, I’m happy to say that the Guest Editors and authors have certainly shed some light on the “black box” of the neurologic system.

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