Q 2.35. Neurological Emergencies and Their Management

1. Introduction:

   • Neurological emergencies require prompt recognition and intervention to prevent further damage.
   • As a medical student, understanding basic principles of evaluation and management is crucial, even if you encounter these emergencies infrequently.

2. Preclinical Years Inside the Classroom:

   • Neuroanatomy Foundation:
     • Build a solid understanding of neuroanatomy. Knowing pathways and system functions simplifies learning about neurological disorders.
     • Focus on localizing lesions based on clinical history and physical exams.
     • Practice self-quizzing on pathways until it becomes second nature.
   • Clinical Vignettes:
     • Exposure to patient cases aids in remembering pathophysiology, diagnosis, and treatment.
     • Hearing about real patients reinforces theoretical knowledge.
   • Board Preparation:
     • Allocate extra study time for board exams.
     • High-yield board review materials help focus on essential content.

3. Neurological Emergencies:

   • These situations appear abruptly and often have a volatile course.
   • Early and aggressive approaches are recommended for management.
   • Common neurological emergencies include:
     • Altered Conscious Level: Immediate assessment and prompt management are crucial to prevent further damage.
     • Seizures: Rapid intervention to stop ongoing seizures.
     • Stroke: Rapid evaluation for thrombolysis or endovascular therapy.
     • Meningitis/Encephalitis: Early antibiotics or antivirals.
     • Increased Intracranial Pressure: Swift measures to reduce pressure.
     • Status Epilepticus: Urgent seizure control.
     • Neuromuscular Respiratory Failure: Ventilatory support.
     • Spinal Cord Compression: Immediate decompression.
     • Neuroleptic Malignant Syndrome: Discontinue offending drugs.
     • Myasthenic Crisis: Respiratory support and immunotherapy.
     • Guillain-Barré Syndrome: Plasmapheresis or immunoglobulins.
     • Neurovascular Emergencies: Aneurysm rupture, arteriovenous malformation, etc.
     • Neuro-Oncological Emergencies: Seizures, raised intracranial pressure, etc.

Remember, your neurology clerkship provides valuable exposure to these emergencies. Stay curious, learn actively, and apply your knowledge compassionately! 

References:

1 aan.com

2 academic.oup.com

3 books.google.com

4 link.springer.com

5 library.med.utah.edu