There are few acute medical conditions that can quickly cause a young healthy adult to die. A non exhaustive list of these are: ruptured appendix, pulmonary embolism, deep venous thrombolism, ectopic pregnancy, heat stroke, stroke, heart attack (sudden cardiac arrest), and meningitis. With this blog being about neurologic emergencies I posit as significant that 3 of those have neurologic components. Stroke, meningitis and heat stroke are all neurologic emergencies with a risk of rapid or sudden death involving brain damage. With prompt intervention all three have treatment options with reasonable expectation of good outcomes.

Heat stroke is a condition that can produce core body temperatures in excess of 107°C. Such temperatures are lethal to brain cells. The diagnosis of heat stroke is relatively straight forward: high body temperature and often a lack or cessation of sweating. The acute treatment can be as simple as controlled cooling with maintenance of hydration. So intense levels of diagnostic and therapeutic technology are not needed to address this condition, but I wanted to bring it up here because it is a case where time is brain and treatment is key and therefore worth the brief reminder.

The diagnosis of ischemic versus hemorrhagic stroke is more complicated and currently requires fairly advanced imaging technologies. There is also interest in differentiating these strokes in the pre-hospital and acute settings without the need or delay of imaging. This is pivotal because the treatments are drastically different. Ischemic stroke can be treated with rt-PA and hemorrhagic stroke needs to be evaluated for neurosurgical intervention. Being wrong could be catastrophic because giving rt-PA to a hemorrhagic stroke patient might lead to much more hemorrhaging.

Meningitis is a condition that currently can take days to diagnose. Typically with a high suspicion of meningitis the physician will start a patient on antibiotics without knowing the cause or presence of an infection. After culturing the spinal fluid an infection and microbe can be identified and only then the treatment tailored to the patients’ condition. While often a medical emergency the pre-hospital practitioner is at this time limited in transport to appropriate medical facility and supportive care.

In conclusion neurologic emergencies can have improved outcomes when the pre-hospital community is actively involved in care, diagnosis, treatment and transport of these patients. Importantly there is a lot of room to grow in these areas with exciting technologies on the horizon. Part of my goal with this blog is to bring these new technologies up as they start coming on line, so please stay tuned.