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.


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