Category: Neurology

Status Epilepticus (Critical Diagnosis)

On occasion, seizures won’t stop, or a seizure lasts longer then 5 minutes. Unlike a simple, single, resolved seizure, status epilepticus is an emergency. In these scenarios, we add to the descriptive and diagnostic workup discussed last week, and move on to a focused treatment algorithm to stop the seizure as soon as possible.

Seizure

One of the most common neurologic complaints we encounter in the Emergency Department is seizure. Typically, a patient with epilepsy will have a breakthrough seizure, or somebody will try some drugs and get a seizure, or the seizure will be the first symptom of a dangerous medical condition. Regardless, 911 will almost always get called if the seizure is witnessed, and by the time the patient gets to you, the seizure is almost completely resolved or they are stable and post-ictal. It is our job to sort through these cases.

Vertigo

There are two big categories of vertigo: central and peripheral. And your entire exam should be focused around identifying which type the patient has. Central vertigo is typically the one we get most concerned about in the ED because it is caused by abnormalities in the brain. Peripheral causes tend to be much less critical and located in the ear. Today we will cover both types, with a specific focus on identifying the life threats.

Stroke (Critical Diagnosis)

Today we are talking about the critical diagnosis of stroke. Specifically, we need to discuss what to do during ischemic strokes. And the most important thing to remember is that TIME IS BRAIN. If you ever suspect that your patient is having a stroke, you need to get your attending immediately. After that, stroke protocols follow a very regimented pattern that we will be overviewing today.

Altered Mental Status

AEIOU TIPS. This is easily one of the most important mnemonics of emergency medicine because it represents the differential diagnosis for altered mental status. Obviously, this is not meant to be an exhaustive list, but it certainly provides a good framework to start with. Even as a resident, I still will write out this differential when I’m placing orders on a complicated, altered mental status patient. It keeps me from  missing something obvious, and it’s crucial for your training as a medical student.

Headache

Headache is one of the most common chief complaints that you will see on your clerkship. Luckily, it is also one of my favorite cases to evaluate. Why do I love it so much? Because I don’t need to be completely dependent on ancillary testing! IT’S ALL ABOUT THE HISTORY AND EXAM. In this episode, we will cover the critical differential diagnosis for headache, the key red flags, exam, and a simple plan. This is a CORE neurologic topic. So listen extra closely today, and be sure to check out the website if you need a written summary  of the content.