High-Risk Chief Complaints III: Neurologic Emergencies

Danielle E Smith; Matthew S Siket

doi:10.1016/j.emc.2020.02.006

High-Risk Chief Complaints III: Neurologic Emergencies

Emerg Med Clin North Am. 2020 May;38(2):523-537. doi: 10.1016/j.emc.2020.02.006.

Authors

Danielle E Smith¹, Matthew S Siket²

Affiliations

¹ Robert Larner College of Medicine of the University of Vermont, 89 Beaumont Avenue, Burlington, VT 05405, USA.
² Surgery, Larner College of Medicine at the University of Vermont, 111 Colchester Avenue, EC 2, Burlington, VT 05401, USA. Electronic address: matthew.siket@uvmhealth.org.

PMID: 32336338
DOI: 10.1016/j.emc.2020.02.006

Abstract

A careful history and thorough physical examination are necessary in patients presenting with acute neurologic dysfunction. Patients presenting with headache should be screened for red-flag criteria that suggest a dangerous secondary cause warranting imaging and further diagnostic workup. Dizziness is a vague complaint; focusing on timing, triggers, and examination findings can help reduce diagnostic error. Most patients presenting with back pain do not require emergent imaging, but those with new neurologic deficits or signs/symptoms concerning for acute infection or cord compression warrant MRI. Delay to diagnosis and treatment of acute ischemic stroke is a frequent reason for medical malpractice claims.

Keywords: Cauda equina; Diagnostic error; Status epilepticus; Stroke; Subarachnoid hemorrhage.

Publication types

Review

MeSH terms

Back Pain / diagnosis
Back Pain / etiology
Back Pain / therapy
Dizziness / diagnosis
Dizziness / etiology
Dizziness / therapy
Emergency Service, Hospital*
Headache / diagnosis
Headache / etiology
Headache / therapy
Humans
Malpractice
Nervous System Diseases / diagnosis*
Nervous System Diseases / therapy
Risk Management
Seizures / diagnosis
Seizures / etiology
Seizures / therapy