Neurocritical Care and Emergencies
Emergency Neurology Mindset
Core priorities
In neurologic emergencies, the first question is not the diagnosis but whether the patient is protecting airway, breathing, and circulation while preserving brain and spinal cord function.
Time-sensitive approach
Early recognition and escalation matter because neurologic injury can become irreversible quickly.
Common emergencies
Coma
- Evaluate brainstem reflexes, glucose, toxic-metabolic causes
Raised intracranial pressure
- Headache, vomiting, papilledema, declining consciousness
Which bedside finding most strongly suggests brainstem function is impaired in a comatose patient?
Brainstem reflex abnormalities help localize severe injury and gauge coma depth.
Correct answer: Abnormal pupillary or corneal reflexes
Why is point-of-care glucose checked early in altered mental status?
Glucose is a common, treatable cause of coma or focal-appearing deficits.
Correct answer: because hypoglycemia is rapidly reversible and can mimic neurologic catastrophe
Raised Intracranial Pressure and Herniation
Danger signs
Increasing intracranial pressure can compress brain structures and cause herniation syndromes. Signs include progressive somnolence, vomiting, pupillary changes, and abnormal posturing.
Initial response to suspected raised ICP
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1
Step 1: Call for urgent help and monitor airway, breathing, and circulation.
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2
Step 2: Elevate the head and optimize oxygenation and ventilation.
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3
Step 3: Rapidly identify mass lesion, hydrocephalus, or hemorrhage.
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4
Step 4: Escalate to definitive neurocritical or neurosurgical management.
A dilated, poorly reactive pupil in a deteriorating patient can be a sign of:
Compression of the third nerve can occur with uncal herniation.
Correct answer: Uncal herniation
What symptom triad should make you worry about spinal cord compression?
These findings, especially with a sensory level, are red flags for cord compression.
Correct answer: back pain, weakness, and bladder dysfunction
Acute Weakness Triage
Potential causes of acute weakness
| Category | Examples |
|---|---|
| Central nervous system | Stroke, cord lesion |
| Peripheral nerve/root | Guillain-Barré syndrome, radiculopathy |
| Neuromuscular junction | Myasthenic crisis, botulism |
| Muscle | Inflammatory or metabolic myopathy |
Ascending weakness with areflexia after a recent infection suggests:
This is a classic pattern for acute inflammatory demyelinating polyradiculoneuropathy.
Correct answer: Guillain-Barré syndrome
Why is respiratory monitoring important in acute neuromuscular weakness?
Some neuromuscular disorders threaten ventilation and require early airway support.
Correct answer: because respiratory muscles can fail quickly