Catastrophic Neurologic Disorders in the Emergency Department , 2nd Edition

Preface to the First Edition

The first 60 minutes (“golden hour”) in acute neurologic emergencies remain critical, and failure to intervene immediately may result in poor outcome.

Currently available books on neurologic emergencies in the emergency department do not reach beyond the basics of neurologic examination and interpretation of the findings. This book tries to fill the need for a resource for neurologists, emergency room physicians, and neurosurgeons who evaluate, treat, and transfer patients with catastrophic neurologic disorders. Critical care neurology is often interdependent with other clinical disciplines, and the book should also be useful for any physician in the emergency department who interacts with neurologists. The material is written from a neurologist's perspective, but the approach by emergency department physicians is reflected as well.

This monograph completes my three-part book project on critical care neurology. The third book not only offers a practical approach to major neurologic disorders but also links early management in the emergency department with more prolonged care in the intensive care unit. It focuses on rapid but accurate neurologic assessment, on the most useful bedside tests, and particularly on interpretation of neuroradiologic images. The organization of the book is standardized, with a major focus on priorities of initial stabilization. I have placed great emphasis on the predictive value of diagnostic tests when they are available. The chapters are interspersed with flow diagrams to facilitate decision making and boxed capsules covering major topics in the subject under discussion. The text is brief to facilitate reading. Its aim is to quickly explain, not to fully discuss, complex topics. It is intended to reflect the train of thought and action in the emergency department.

This book draws on new material on evaluation and management of major neurologic disorders, but at the risk of presumption I feel compelled to state that it is also the result of years of contemplation of these problems and all I could find to read on the subject. However, in a discipline in its formative years, the “whats” are plentiful and the “whys” fewer. I hope this book is an informative guide to the recognition and management of acute neurologic catastrophes at their early stage of presentation and finds its way to neurologists, neurosurgeons, neuroradiologists, emergency physicians, residents, and fellows in these specialties.