Neurologic and Psychiatric Emergencies

A sudden, violent “thunderclap headache” is the main symptom of subarachnoid hemorrhage (SAH). Mostly, this intracerebral hemorrhage is caused by the rupture of an aneurysm. The lethality rate in SAH cases has fallen in recent years, but not the number of incidences. Patients who survive SAH cases, are at an increased risk of having cardiovascular and neurovascular diseases. All the facts on symptoms, diagnosis and treatment are presented in this article in a compact way, together with all the test-relevant details. This will definitely assist you to be in perfect preparation for your final examinations.

Intracranial hemorrhage is a medical emergency that occurs in adults, but can also occur in children and neonates. As the name suggests, intracranial hemorrhage is bleeding and the accumulation of blood within the skull at an abnormal location leading to the formation of a hematoma. A hematoma is the collection of blood outside of blood vessel. Intracranial bleeding can lead to stroke, neurological deficit, brain matter herniation, and even death.

Hemorrhagic stroke is the second most common form of acute strokes. Patients can develop a hemorrhagic stroke due to many risk factors which include hypertension, cerebral amyloid angiopathy, neoplastic diseases and cerebral aneurysms. Hemorrhagic strokes can be classified into subarachnoid or intracerebral hemorrhage depending on the site of the hematoma formation. The semiology is usually similar to ischemic stroke; therefore, adequate brain imaging is very important for proper diagnosis and management.

Viral encephalitis is defined as the inflammation of the central nervous system due to viral agents. Several viruses can cause encephalitis, but herpes viruses are the most commonly implicated. Patients present with confusion, altered level of consciousness, seizures and focal neurologic signs. Polymerase chain reaction testing can help identify the causative organism in a few cases, but antiviral therapy should be initiated immediately in any suspected case regardless of the diagnosis confirmation.

Headache is one of the most common symptoms in the emergency department and outpatient clinics. It can be a sign for serious illness that needs immediate action to prevent fatal consequences e.g. subarachnoid hemorrhage, meningitis and temporal arteritis. Headache also can be a sign of chronic physical and mental illnesses. Careful history taking and physical examination should be performed to any patient complaining of headache for proper diagnosis and management.

Patients with chronic medical conditions, those with psychiatric disorders such as a major depressive disorder, and veterans and those with psychotic disorders are at an increased risk of suicidal ideation, attempt, or death. The assessment of suicide risk in the patient is very important as it can help in preventing a serious suicide attempt that might cause death; therefore, the main purpose of suicidal risk assessment tools is to direct and guide specific suicide prevention interventions.

At the emergency department, it is quite common to see a patient presenting with seizures. In this article, we will cover the following topics: seizures’ management at the emergency department, management and diagnostic workup for the first seizure, and epilepsy emergencies.

Altered mental status (AMS) is a common presentation to the emergency department that comprises a group of clinical symptoms rather than a specific diagnosis. Patients with AMS present with cognitive, attention, arousal, or consciousness disruption. To understand emergency medicine, you should gain essential information about altered mental status.