Neurological and Psychiatric Emergencies
Core concepts
Know the time-critical neurological emergencies: acute ischemic stroke, intracerebral hemorrhage, status epilepticus, and bacterial meningitis. For stroke, understand the time window for thrombolysis, contraindications, and the role of thrombectomy in large-vessel occlusion. Recognize the difference between ischemic and hemorrhagic stroke on clinical grounds and imaging.
Status epilepticus requires a stepwise approach: benzodiazepines first, then second-line antiepileptics, then escalation. Understand altered mental status evaluation (the "coma cocktail" concept and reversible causes). In psychiatric emergencies, know risk assessment for suicide, safe management of agitation (de-escalation first, then pharmacologic), and recognition of serotonin syndrome, neuroleptic malignant syndrome, and alcohol withdrawal.
Traps
Questions test whether you can distinguish stroke mimics (hypoglycemia, seizure, migraine, conversion) - always check glucose. Another trap is missing subarachnoid hemorrhage presenting as a "worst-ever headache" with a normal early CT. Watch for the patient with fever, neck stiffness, and altered mentation where antibiotics must not be delayed by lumbar puncture.
Worked example / rule of thumb
Sudden focal deficit with a clear last-known-well time: activate stroke pathway, check glucose, obtain CT. Rule of thumb: "Time is brain - but check glucose first and never delay antibiotics for a lumbar puncture in suspected meningitis."