Initial Diagnosis and Pitfalls for Neurological Emergency in The Tertiary Critical Care Medical Center

Abstract

To resuscitate acutely ill neurological patients, prompt and accurate diagnosis followed by the professional treatment is desirable. Initial management in neurological emergency, however, carries a significant risk to fall into pitfalls. To avoid unpredictable devastating outcome, possible life-threatening illness should be recognized. We presented our experience to call attention to such misleading critical illness: neurogenic stunned myocardium, neurological symptoms related to acute aortic dissection, intracranial arterial dissection, etc. Lack of reciprocal ST segment depression in electrocardiogram indicates neurogenic stunned myocardium rather than acute myocardial infarction. An elevated level of serum fibrinolytic marker is useful for screening of acute aortic dissection. Above all, history taking with core knowledge of certain life-threatening critical disorders is the clue to correct diagnosis. Collaboration of dedicated physicians and surgeons is warranted to develop sophisticated treatment standards of neurological emergency and critical care.