Neurologic Emergencies—Making the Diagnosis and Treating the Life Threats

Jonathan A. Edlow, MD, Editor

Michael K. Abraham, MD, MS, Editor

When Dr Amal Mattu asked us to consider organizing and editing this issue of Emergency Medicine Clinics of North America , we both had to say yes. This is, in part, due to our respect for him, but also to our interest in and commitment to improving the care of our patients who present to the emergency department with acute neurologic problems. This group of patients is not an insignificant number, and most estimates suggest that between 5% and 8% of all patients seen in an emergency department have neurologic issues. If you need confirmation, simply think about your last shift and consider how many patients had back pain or headache or dizziness or altered mentation. Most of these patients have fairly trivial and often self-limited problems. However, as with emergency medicine in general, there are the needles in the haystack.

Several decades ago, when one of us started practicing emergency medicine, the range of diagnostic imaging was quite limited and the menu of various therapeutic options for patients with neurologic problems even more so. Computed Tomography (CT) scan was available, but often only during daytime hours. MRI was still on the drawing board. TPA was a couple of decades away. The notion that treating patients with transient ischemic attack (TIA) within the first couple of days could reduce the outcome of stroke did not exist. Phenobarbital was a common treatment for patients with status epilepticus, and the probability of getting an EEG in the emergency department was essentially zero. My younger counterpart wasn’t so lucky.

For quite some time, a spirit of therapeutic nihilism existed for patients with neurologic emergencies. Neurologic emergencies incite fear into emergency physicians as they can be more complicated than many of the other critical issues that confront emergency physicians every day. But the range of diagnostic modalities and the various treatments that are now available for these patients have markedly expanded in the last two decades and therapeutic nihilism is no longer an option. Not surprisingly, this group of patients is an important source of medicolegal liability for the clinician.

We have therefore organized this issue to cover the common neurologic symptoms that emergency physicians encounter regularly (back pain, visual symptoms, headache, weakness, and altered mental status) as well as the important areas of central nervous system infections, and the recognition and treatment of patients with acute cerebrovascular emergencies (ischemic and hemorrhagic stroke, TIA, and subarachnoid hemorrhage). We’ve also included an article about neurologic conditions affecting pregnant and postpartum women because of its special high-risk nature. We believe that we have recruited an all-star list of authors for this issue. We believe that the result is a truly cutting-edge issue that will help emergency clinicians better diagnose and treat their patients with these neurologic conditions. We hope that the content of this issue helps to improve patient safety and patient outcomes.

When possible, we have tried to include illustrations, tables, and algorithms to help clarify the clinical approach to these patients.

We would both like to thank our families for their understanding, our colleagues for their support, and most of all, our patients for their inspiration. We would also like to thank the editorial staff at Elsevier for their important contributions to this issue. All of these individuals have helped to make this issue of Emergency Medicine Clinics of North America the success that we believe it is.

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