Neurological and Psychiatric Emergencies
This domain tests acute stroke, seizures and status epilepticus, headache red flags, altered consciousness, delirium, and suicide risk. The exam expects rapid exclusion of reversible medical causes before labelling symptoms psychiatric.
Core rules
- Check capillary glucose immediately in any neurological presentation.
- Acute ischaemic stroke: establish last-known-well time, perform non-contrast CT to exclude haemorrhage, and assess thrombolysis/thrombectomy eligibility. Do not delay imaging for unnecessary tests.
- Status epilepticus: secure airway, give a benzodiazepine, then a second-line antiseizure drug; treat hypoglycaemia and other causes.
- Subarachnoid haemorrhage: sudden maximal headache; CT is sensitive early, and lumbar puncture may be needed later in selected cases.
- Psychiatric emergencies: assess immediate safety, agitation, psychosis, and suicide risk; treat medical delirium before assuming primary psychiatric illness.
Worked example
A 70-year-old wakes with right-sided weakness. Last known well was 9 hours earlier. Glucose is normal and CT excludes haemorrhage. Thrombolysis is outside the usual window, but thrombectomy may be considered if large-vessel occlusion is present and imaging criteria are met.
Traps
- Do not give thrombolysis before excluding intracerebral haemorrhage.
- Do not miss hypoglycaemia, hypoxia, or drug toxicity mimicking stroke or psychosis.
- Do not attribute first seizure in an older adult to epilepsy without investigation.
- Do not overlook carbon monoxide poisoning in headache with altered mental status.