The article Blood Pressure Management in Neurologic Emergencies emphasizes the importance of timely and effective blood pressure management in neurologic emergencies. It highlights that elevated blood pressure is a significant prognostic factor in conditions such as stroke, traumatic brain injury, posterior reversible encephalopathy syndrome (PRES) and preeclampsia. The review provides a detailed examination of current recommendations and controversies, offering a practical resource for emergency physicians. This article aims to equip clinicians with the knowledge to balance rapid intervention with long-term risk mitigation, ultimately improving patient outcomes.

The acute management of intracerebral hemorrhage (ICH) is critically time-sensitive to decrease risk of hematoma expansion. This requires processes to be in place for expedited imaging and laboratory studies, careful blood pressure management, anticoagulation reversal, and neurosurgical evaluation for select patients all within the first few hours of presentation. The aim of this article is to provide an updated review on ICH management in the emergency department.

Most patients presenting with headaches to the emergency department (ED) are experiencing benign exacerbations of chronic conditions. The ED focus is on identifying dangerous secondary causes of headaches and providing pain relief. Given the high recurrence rate, emergency physicians must optimize acute treatment, address unmet needs, and ensure appropriate outpatient follow-up.

Headache accounts for 2% to 3% of emergency department visits annually. While the vast majority of these patients have a primary, non-serious cause, a small proportion of these patients have a "cannot miss" secondary cause that if misdiagnosed or have a delay in diagnosis, result in poor patient outcomes. The majority of serious diagnoses include subarachnoid hemorrhage, other types of intracranial hemorrhage including subdural hematoma, strokes, meningitis, and other non-neurologic etiologies. It is important for emergency physicians to identify through a careful history, physical examination, and consideration of epidemiologic factors which patients require extensive testing.

Atraumatic back pain is a common condition affecting a significant portion of adults. Approximately 80% of individuals will experience it during their lifetime, making it a frequent reason for primary care and emergency visits. In the United States, about 4.4 million emergency department (ED) visits in 2021 were due to back pain, representing 2% to 4% of all ED visits. While most cases are benign, serious spinal pathologies occur in 2.5% to 5.1% of ED presentations, requiring prompt diagnosis and management. This review categorizes causes into emergent, "worst first" conditions and less urgent, yet sometimes still critical, etiologies.

Weakness is a challenging and broad chief complaint in emergency medicine, necessitating rapid and accurate differentiation among numerous etiologies. Effective diagnosis involves recognizing symptoms of central and peripheral neurologic disorders, neuromuscular junction diseases, nutritional deficiencies, and toxin exposures. Prompt identification and intervention in conditions such as Guillain-Barré syndrome, transverse myelitis, botulism, and nutritional deficiencies are crucial. Despite vaccines reducing cases of polio, tetanus, and diphtheria, vigilance remains essential due to their potential resurgence. This article emphasizes a systematic evaluation, critical diagnostic challenges, management pitfalls, and future directions for improving patient outcomes.

Neurologic emergencies often require timely access to neuroimaging and accurate diagnosis may be highly dependent on which imaging modality is chosen. It is important for the emergency clinician to have a foundational understanding of the appropriate indications of various neuroimaging modalities to avoid false reassurance and misdiagnosis. The following article is intended to provide an overview of the 2 most common neuroimaging modalities used in the emergency department, computed tomography and MRI, their respective strengths and weaknesses, as well as pearls and pitfalls to ensure accurate, efficient, and appropriate use.

Carotid and vertebral artery dissections are an important cause of stroke in younger patients that can present a diagnostic challenge. Symptoms can range from subtle neck pain and headache to a clear stroke syndrome. Carotid and vertebral artery dissections, referred to as cervical artery dissections, are often associated with a traumatic mechanism of varying severity, and screening has been incorporated into major trauma guidelines. Diagnosis is achieved through vessel imaging, most commonly computed tomography angiography or magnetic resonance angiography. Treatment with antiplatelet or antithrombotic agents depends on individual patient risk factors and is typically continued for 3 to 6 months.

Cerebral venous thrombosis (CVT) is a rare yet serious cerebrovascular condition distinct from arterial stroke. Despite its low prevalence (0.5%-3% of strokes), incidence has risen due to improved awareness and diagnostics. CVT presents variably, commonly with headache, seizures, and focal deficits, making early recognition crucial. Diagnosis relies on CT/MR venography, while anticoagulation remains the mainstay of treatment. Prognosis is generally favorable, though long-term complications such as recurrent thrombosis and cognitive impairment are possible. Emerging research continues to refine diagnostic and management strategies, including anticoagulation choices and treatment of special populations such as pregnant patients.

Acute ischemic stroke is the most prevalent neurologic emergency and a common cause of disability and death in the United States, as well as the rest of the world. As emergency department encounters for stroke are only expected to rise, frontline clinicians should be readily equipped to recognize and treat this disease process. A rapid, accurate history and examination may help screen for large-vessel occlusions, navigate among potential stroke mimics, and even detect subtle clinical chameleons. Awareness of the utility of advanced perfusion and MRI modalities allows clinicians to offer interventions even to those without a clear time of symptom onset.

A transient ischemic attack is an acute neurologic event caused by focal ischemia affecting the brain, eye, or spinal cord, resolving quickly without infarction on magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI). It is a tissue-based diagnosis, highlighting the need for prompt recognition and risk stratification. Evaluation in the emergency department includes detailed history, risk assessment, neurologic examination, and initial noncontrast computed tomography (CT) to rule out other conditions, with MRI DWI as the gold standard for confirming no infarction. Vascular imaging, echocardiography, electrocardiogram (ECG), and laboratories help identify underlying causes. Central retinal artery occlusion (CRAO) requires urgent diagnosis and ophthalmology consultation to prevent permanent vision loss.

A structured, problem-based history and physical examination are essential for accurate diagnosis and treatment of an acutely dizzy patient. The ATTEST or STANDING algorithms are diagnostic approaches for acute vertigo patients presenting to the emergency department. First rule out stroke or look for obvious medical causes. If negative, follow either the ATTEST or STANDING algorithms to differentiate peripheral from central causes of dizziness by separating them into different categories of episodic vestibular syndrome or acute vestibular syndrome. The Dix-Hallpike maneuver is used to diagnose posterior canal benign positional paroxysmal vertigo in patients with triggered episodic vestibular syndrome.

This article provides a guide to perform a focused and rapid neurologic examination in the emergency department. Though the components are discussed in detail, it is important to appreciate that not every component of the examination will be necessary for every patient. This review provides guidance for the emergency clinician to perform a focused neurologic examination to accurately diagnose potentially life-threatening conditions.

Status epilepticus (SE) is a life-threatening neurological emergency defined by prolonged seizure activity or seizure activity without a return to baseline. SE can lead to permanent neuronal injury, and it is crucial that it be recognized as soon as possible. Management of SE follows a stepwise approach, with benzodiazepines first-line, followed by antiseizure drugs, and finally with anesthetics. Assessing airway status, along with checking for hypoglycemia and pregnancy status in reproductive-age women, are imperative. Nonconvulsive SE can be difficult to diagnose and requires EEG for detection. Special considerations apply for cases of SE in pregnant, elderly, and immunocompromised patients.

This article reviews the management of moderate to severe traumatic brain injury in children, focusing on acute care, imaging, and rehabilitation strategies to mitigate secondary injury and maximize recovery. Key approaches include using optimal imaging modalities, managing intracranial pressure, and employing targeted rehabilitation. Biomarkers and novel therapies are under investigation, while postacute support emphasizes cognitive, physical, and psychosocial rehabilitation to enhance long-term quality of life.

Tonsillectomy and adenoidectomy are among the most frequent pediatric surgical procedures performed in the United States. Approximately 5% of patients will experience a post-tonsillectomy hemorrhage. Due to the risk of recurrence, even resolved bleeds require otolaryngology consultation. Nearly 30% of patients will have a second bleed. Approximately 40% of second bleeding episodes occur the day following the initial bleed and 10% of all patients with minor bleeding develop severe bleeding. Patients presenting with active bleeding constitute a surgical emergency. Initial assessment and primary survey should prioritize airway management and hemodynamic stability.

Challenges in pediatric resuscitation include infrequent occurrence, size-specific equipment, variable patient size, and anatomy. Preparation for the event is essential. Knowledge of airway positioning, interventions, available equipment, and initiation settings for mechanical ventilation build a strong foundation. In a peri-arrest patient, crystalloid, vasopressors, and blood products can optimize hemodynamics. In cardiac arrest, high-quality cardiopulmonary resuscitation (CPR), minimal interruptions, and adequate bag valve mask ventilation remains the mainstay of care. Recall critically-ill pediatric patients are at higher risk for hypoglycemia, hypothermia, accidental overdose, and non-accidental trauma. This article summarizes up-to-date evidence and experiential pearls and pitfalls for pediatric resuscitation.