Neurology

A

• Acute Ischemic Stroke — Door‑to‑Needle, Door‑to‑Groin, and Post‑Reperfusion Care

  Rapid triage by last‑known‑well and stroke severity, non‑contrast CT to exclude hemorrhage, CTA for LVO, IV alteplase within 4.5 h when eligible, and mechanical thrombectomy up to 24 h in selected patients; strict BP and neuro monitoring after reperfusion.
• Acute Ischemic Stroke — ED to Reperfusion

  Acute ischemic stroke is a time-critical neurologic emergency in which rapid imaging, reperfusion assessment, and prevention of secondary injury determine outcome. The 2026 AHA/ASA guideline expands use of tenecteplase and endovascular thrombectomy in selected patients while emphasizing that treatment should not be delayed by unnecessary testing.
• Acute Ischemic Stroke — IV Thrombolysis, Endovascular Therapy, and BP Targets

  For eligible patients within 4.5 hours of onset, offer IV thrombolysis. Evaluate for large-vessel occlusion and consider endovascular thrombectomy within 6 hours, and up to 24 hours based on perfusion imaging selection. Maintain BP control (≤185/110 for lysis; permissive hypertension otherwise) and start secondary prevention.
• Acute Ischemic Stroke — Reperfusion Workflow

  Suspected stroke requires rapid imaging, eligibility assessment, and timely IV thrombolytic and or mechanical thrombectomy when indicated; manage blood pressure and glucose and prevent complications.
• Acute Ischemic Stroke — Thrombolysis & Thrombectomy Pathways

  Acute ischemic stroke is a time-critical diagnosis in which treatment eligibility depends on last-known-well time, disabling neurologic deficit, brain imaging, vascular anatomy, blood pressure, and contraindications rather than on waiting for every laboratory result. For eligible patients within 4.5 hours, contemporary guidelines support IV thrombolysis with alteplase or tenecteplase, with tenecteplase increasingly used because of single-bolus administration.
• Acute Ischemic Stroke — Thrombolysis, Thrombectomy, and Blood Pressure Targets

  Rapid recognition with last-known-well time is critical. Noncontrast CT excludes hemorrhage; CTA detects large vessel occlusion. Offer IV thrombolysis within established windows when eligible, and consider mechanical thrombectomy up to 24 h in selected LVO cases; manage BP and glucose tightly.
• Aneurysmal Subarachnoid Hemorrhage — Nimodipine, BP Targets, and Early Securing

  Abrupt severe headache with or without focal deficits; CT ± LP for diagnosis. Start nimodipine for vasospasm prophylaxis, manage BP, and secure aneurysm early via coiling or clipping; monitor for hydrocephalus, hyponatremia, and DCI in a neuro‑ICU.

B

• Bacterial Meningitis — Adult

  Acute bacterial meningitis is a neurologic and infectious emergency in which delays in effective antimicrobial therapy can worsen outcome. In adults, diagnosis rests on the clinical syndrome plus cerebrospinal fluid and microbiologic testing, but treatment should begin before lumbar puncture or neuroimaging when those procedures would meaningfully delay antibiotics. Empiric therapy is selected by age, immune status, likely source, and risk for resistant organisms, with adjunctive dexamethasone given before

C

• Cauda Equina Syndrome — Red Flags and Urgent MRI

  Cauda equina syndrome is a time-critical compressive neurologic emergency involving the lumbosacral nerve roots. Suspect it with new urinary retention or altered bladder sensation, saddle or perineal sensory change, bilateral or progressive radicular symptoms, lower-extremity weakness, or bowel/sexual dysfunction. Perform an urgent neurologic examination and bladder assessment and obtain emergency MRI of the lumbar spine. Neurosurgical or spine consultation should occur as soon as compression is suspected b
• Central Cord Syndrome — Airway, Immobilization, and Timing of Decompression

  Hyperextension injury with hand weakness greater than legs and variable sensory loss; stabilize the spine, optimize hemodynamics, and involve spine surgery to consider early decompression when deficits persist or instability exists.
• Cerebral Venous Sinus Thrombosis — Postpartum Headache, MRI/MRV, and Anticoagulation

  CVST presents with headache, focal deficits, seizures, or papilledema, often postpartum or with prothrombotic states. Diagnose with MRV/CTV and start therapeutic anticoagulation even with venous hemorrhage unless contraindicated.
• Chronic Migraine — Preventive Therapies & CGRP

  Chronic migraine is defined by headache on at least 15 days per month for more than three months, with migraine features on at least eight days per month. Offer preventive therapy when attacks are frequent or disabling.
• Cluster Headache — Acute & Preventive Treatment

  Cluster headache causes excruciating unilateral orbital, supraorbital, or temporal pain lasting 15-180 minutes with ipsilateral autonomic features such as lacrimation, conjunctival injection, nasal congestion, rhinorrhea, ptosis, or miosis. Treat acute attacks immediately with 100% oxygen delivered through a nonrebreather mask at high flow, commonly 12-15 L/min or higher as needed, and/or subcutaneous sumatriptan 6 mg.

E

• Essential Tremor — Diagnosis & Treatment

  Essential tremor is an isolated or predominantly action tremor syndrome, usually bilateral in the upper limbs, that can also involve the head or voice. Propranolol and primidone are first-line therapies for bothersome limb tremor.

F

• First Seizure in Adults — ED Evaluation

  A first seizure in an adult requires confirmation that the event was epileptic, identification of immediately reversible causes, assessment for structural brain disease or infection, and estimation of recurrence risk. Glucose and electrolytes are core tests, neuroimaging is targeted to risk, and antiseizure medication after an unprovoked seizure is individualized rather than automatic.
• Functional Neurological Disorder — Recognition & Management

  Functional neurological disorder is diagnosed by positive clinical signs showing internal inconsistency or a pattern incompatible with recognized neurologic disease—not merely because tests are normal. Effective treatment starts with a clear, nonjudgmental explanation that the nervous system's function is disrupted even though the structure may be intact.

G

• Guillain‑Barré Syndrome (AIDP) — Respiratory Monitoring, IVIG/PLEX, and Autonomic Care

  Progressive symmetric weakness with areflexia after infection; monitor FVC/NIF for impending respiratory failure. Treat with IVIG or plasma exchange (equivalent efficacy) and manage pain and dysautonomia; avoid steroids.

I

• Idiopathic Intracranial Hypertension — Diagnostic Criteria and Stepwise Therapy

  Obese woman of childbearing age with daily headache and papilledema—consider idiopathic intracranial hypertension (IIH).
• Intracerebral Hemorrhage — Acute Management

  Spontaneous intracerebral hemorrhage is acute bleeding into the brain parenchyma and carries high early mortality. Immediate priorities are airway and hemodynamic stabilization, rapid noncontrast CT, reversal of clinically significant anticoagulation, smooth blood-pressure control when indicated, neurosurgical assessment for selected hemorrhages, and management in a stroke or neurocritical-care setting. Prognostic scores can describe severity but should not be used alone to justify early limitation of life-
• Ischemic Stroke — Thrombolysis and Thrombectomy

  Acute ischemic stroke is a time-critical neurologic emergency in which eligible patients may benefit from intravenous thrombolysis, endovascular thrombectomy, or both. The 2026 AHA/ASA guideline supports either tenecteplase or alteplase in appropriate patients within the standard 4.5-hour window, expands imaging-selected reperfusion pathways, and broadens thrombectomy eligibility for selected large-vessel and basilar-artery occlusions.

L

• Lambert–Eaton Myasthenic Syndrome — Diagnosis & Oncology Links

  Lambert-Eaton myasthenic syndrome is a presynaptic neuromuscular-junction disorder characterized by proximal leg-predominant weakness, autonomic symptoms, and reduced reflexes that may transiently improve after brief exercise. Treat an identified cancer because tumor control can improve neurologic disease.

M

• Mild Traumatic Brain Injury — Concussion in Adults

  Adult concussion is a mild traumatic brain injury diagnosed clinically after biomechanical head or body trauma produces transient neurologic dysfunction. ED priorities are to identify patients who need CT for intracranial injury, avoid unnecessary repeat imaging or admission after a reassuring evaluation, provide clear return precautions, and guide a gradual return to cognitive and physical activity after a brief period of relative rest.
• Myasthenic Crisis — Airway Protection, IVIG/Plasma Exchange, and Trigger Control

  Acute worsening of myasthenia gravis with respiratory or bulbar failure. Monitor VC/NIF, prepare for early intubation, hold cholinesterase inhibitors if excessive secretions, and treat with IVIG or plasma exchange; identify triggers (infection, medications). Corticosteroids and immunomodulators follow stabilization.
• Myasthenic Crisis — Airway Strategy, IVIG vs PLEX, and Weaning

  Impending respiratory failure from myasthenia gravis requires ICU-level care; plan early airway strategy, treat with IVIG or plasma exchange, optimize anticholinesterase and immunotherapy, and prevent precipitants while using objective measures to guide extubation.
• Myasthenic Crisis — Airway Strategy, IVIG/Plasma Exchange, and Medication Optimization

  Crisis is respiratory failure from myasthenia gravis. Monitor VC and NIF closely; intubate early if declining. Treat with IVIG or plasma exchange; manage triggers and adjust anticholinesterase and immunosuppressive therapy. Avoid exacerbating drugs (aminoglycosides, fluoroquinolones, magnesium).
• Myasthenic Crisis — Respiratory and Immunotherapy

  Myasthenic crisis is severe myasthenia gravis weakness causing or threatening respiratory failure, often precipitated by infection, surgery, medication exposure, or inadequate immunotherapy. Monitor respiratory mechanics and bulbar function closely, secure the airway before exhaustion or aspiration occurs, and use plasma exchange or IVIG as rapid immunomodulatory therapy.

N

• Neuroleptic Malignant Syndrome — Dopamine Agonists, Dantrolene, and Supportive ICU Care

  Idiosyncratic reaction to dopamine antagonists or withdrawal of dopaminergic drugs. Presents with hyperthermia, rigidity, autonomic instability, and elevated CK. Stop offending agents, provide aggressive supportive care, and consider dantrolene, bromocriptine, or amantadine in moderate–severe cases.
• Neuroleptic Malignant Syndrome — Recognition and Treatment

  Severe reaction to dopamine antagonists with hyperthermia, rigidity, and autonomic instability; stop offending agent, provide ICU supportive care, and consider bromocriptine or dantrolene.

P

• Peripheral Neuropathy — Evaluation & Reversible Causes

  Peripheral neuropathy is a syndrome rather than a single diagnosis. Treat the underlying cause whenever possible: improve diabetes control without provoking hypoglycemia, replace B12, stop a neurotoxin, address alcohol use, treat monoclonal or inflammatory disease, and correct nutritional deficits.
• Posterior Reversible Encephalopathy Syndrome (PRES) — Triggers, MRI, and BP/Seizure Control

  Headache, encephalopathy, visual symptoms, and seizures in the setting of acute BP fluctuation, cytotoxic therapy, autoimmune disease, or eclampsia. MRI shows posterior‑predominant vasogenic edema. Treat by removing the trigger, controlled BP reduction, magnesium in eclampsia, and antiepileptics; most cases improve within days to weeks.

R

• Restless Legs Syndrome — Diagnosis & Treatment

  Restless legs syndrome is defined by an urge to move the legs, usually with uncomfortable sensations, that begins or worsens during rest, improves with movement, and is worse in the evening or night. Correct iron deficiency, reduce aggravating medications when possible, and encourage regular sleep, moderate exercise, and avoidance of excessive caffeine/alcohol.

S

• Secondary Stroke Prevention — Antiplatelets & Risk Factors

  Secondary prevention after ischemic stroke or TIA is mechanism-specific. For most noncardioembolic stroke, use long-term single antiplatelet therapy.
• Spontaneous Intracerebral Hemorrhage — BP Targets, Reversal, and ICU Care

  Urgent BP reduction, reversal of anticoagulation, neurosurgical consultation for select cases, and neurocritical monitoring. Consider hematoma expansion risk and spot sign; manage glucose, temperature, and DVT prophylaxis appropriately.
• Spontaneous Intracerebral Hemorrhage — Reversal, BP Control, and Neurosurgical Triage

  Nontraumatic ICH requires rapid BP control (often SBP 140–160), urgent reversal of anticoagulants, and neurocritical care. Identify candidates for neurosurgical intervention (posterior fossa, large lobar with mass effect) and manage ICP/airway; avoid hyperglycemia and fever.
• Status Epilepticus — Adult

  Convulsive status epilepticus is continuous seizure activity lasting at least 5 minutes or recurrent seizures without recovery to baseline between events. Treatment should begin at the 5-minute threshold because spontaneous termination becomes less likely as seizure duration increases. Adequately dosed benzodiazepine is first-line therapy, immediately followed by a full loading dose of a second-line antiseizure medication if seizure activity continues. Persistent status after these steps requires intensive-
• Status Epilepticus — Adult Management

  Convulsive status epilepticus is a neurologic emergency requiring treatment once a generalized convulsive seizure persists for about 5 minutes or recurrent seizures occur without recovery. Stabilize airway and oxygenation, check glucose, give an adequately dosed benzodiazepine promptly, then administer a full-dose second-line antiseizure medication such as levetiracetam, fosphenytoin, or valproate if seizures continue. Refractory status requires ICU care, continuous EEG, and anesthetic therapy while the und
• Status Epilepticus — Benzodiazepine First, Second-Line Antiseizure, and Anesthetic Infusion

  Seizures >5 minutes or recurrent without recovery require protocolized treatment. Give benzodiazepines promptly (IM midazolam or IV lorazepam), followed by a weight-based second-line agent (levetiracetam/valproate/fosphenytoin). Refractory cases require intubation and anesthetic infusions with continuous EEG.
• Status Epilepticus — Benzodiazepines First, Second‑Line ASMs, and Refractory Care

  Seizure activity ≥5 minutes (or recurrent without recovery) warrants immediate benzodiazepines followed by second‑line antiseizure medications (levetiracetam, valproate, or fosphenytoin). Refractory cases require anesthetic infusions and ICU care.
• Status Epilepticus — Benzodiazepines, Second-Line Antiseizure Meds, and Refractory Anesthesia

  Seizure >5 minutes or recurrent seizures without recovery is status epilepticus. Give IM/IV benzodiazepines immediately, then load levetiracetam, fosphenytoin, or valproate. For refractory cases, intubate and start continuous anesthetic infusion with EEG monitoring while treating precipitants.
• Subarachnoid Hemorrhage — Diagnosis & Early Management

  Aneurysmal subarachnoid hemorrhage is bleeding into the subarachnoid space from a ruptured intracranial aneurysm and classically presents with sudden severe headache. It is a neurovascular emergency because rebleeding, hydrocephalus, seizures, cerebral edema, and delayed cerebral ischemia can cause rapid deterioration. Diagnosis begins with urgent noncontrast CT, followed by additional testing when CT is negative but clinical suspicion remains. Once identified, patients should be transferred to an experienc
• Subarachnoid Hemorrhage — Early ED Management

  Secure ABCs, control pain and blood pressure, prevent rebleeding, treat nausea, and arrange rapid neurosurgical care; consider nimodipine and seizure prophylaxis per local practice.
• Subarachnoid Hemorrhage — Thunderclap Workup

  Aneurysmal subarachnoid hemorrhage typically presents with sudden severe thunderclap headache and can rapidly cause rebleeding, hydrocephalus, seizure, arrhythmia, and death. Obtain emergent noncontrast head CT. If CT is negative but clinically important SAH remains possible, use a time-sensitive diagnostic pathway with lumbar puncture or vascular imaging according to the timing, scanner quality, local protocol, and patient factors. Once SAH is diagnosed, control blood pressure without inducing hypotension,

T

• Transient Ischemic Attack — ED Workup and Disposition

  Transient ischemic attack is a transient focal neurologic syndrome caused by ischemia without established infarction and is a warning of early stroke risk. ED care requires rapid confirmation that symptoms were focal, urgent brain and vascular imaging, evaluation for atrial fibrillation and other embolic sources, immediate secondary prevention when safe, and disposition based on the ability to complete an expedited stroke workup rather than an ABCD2 score alone.
• Transverse Myelitis — Workup & Acute Treatment

  Transverse myelitis is an inflammatory spinal cord syndrome causing motor, sensory, and autonomic dysfunction over hours to days. For a significant inflammatory myelitis, give high-dose IV methylprednisolone, commonly 1 g daily for 3-5 days in adults.