Catastrophic Neurologic Disorders in the Emergency Department , 2nd Edition

Preface to the Second Edition

This book is part of a trilogy on critical care neurology published by Oxford University Press. Although some overlap is unavoidable, it stands separately from the others. I have always considered this monograph a serious attempt to fuse a neuroradiology text—adapted to acute neurologic conditions—with an emergency neurology manual, but without compromising academic rigor.

The second edition of Catastrophic Neurologic Disorders in the Emergency Department retains its unique organization with multiple examples of neuroimaging, algorithms, and inserts with background information (boxes). The title changed somewhat because several reviewers in the United Kingdom felt the title Neurologic Catastrophes in the Emergency Department implied a medicolegal book. (Not so!)

A neurologic catastrophe is a major interruption of an otherwise coordinated and functioning central or peripheral nervous system. However, the damage of an evolving catastrophe can be lessened if it can be predicted. Therefore, this new edition has an additional focus on urgent neurologic conditions that could rapidly progress into a catastrophic neurologic disorder.

The second edition has a wider scope, with eight additional chapters. Seven of these chapters form a new section on the evaluation of presenting symptoms, and their conversational titles echo common requests for urgent consultation. As one would expect, the differential diagnosis of these symptoms is very broad. However, the chapters emphasize the “red flags” that set the priorities and direction of the clinical approach. The chapters are intentionally brief and convey the initial overlapping of thoughts and action. They are intended only to orient readers, and they are directly clinical. The neurologic disorders considered are then discussed in more detail in Parts II and III, to which a chapter on forensic neurology has been added. The rest of the book has the same layout as the first edition, but I have added figures and updated the text wherever necessary. In some areas, due to new observations, I have changed my mind.

I hope the book will continue to serve as a practical guide for neurologists, neurosurgeons, and other physicians who are called upon to manage or evaluate deteriorating patients in the emergency department. I hope it will also benefit emergency physicians who are stationed there.