Subarachnoid hemorrhage (SAH) has a poor prognosis with a mortality rate of 25-50%. Because re-rupture is highly associated with mortality, a correct diagnosis must be made as soon as possible and the appropriate initial treatment must be performed. Delayed diagnosis due to failure in obtaining a computed tomography (CT) scan or missed diagnosis of SAH on CT can sometimes results in a fatal outcome. A lumbar puncture or magnetic resonance imaging is necessary to diagnose SAH even after a negative CT scan in cases wherein SAH is suspected based on symptoms. Although there is a general consensus that analgesia, sedation, and blood pressure lowering should be performed in the initial treatment of SAH, for sedation and blood pressure control protocols have not been defined. In cases with a poor-grade SAH, intracranial pressure (ICP) and cardiovascular complications should be properly managed. Placement of an external ventricular drain is recommended for acute hydrocephalus. Three-dimensional computed tomography angiography (3D-CTA) has recently been used for identifying the bleeding source. However, 3D digital subtraction angiography (3D-DSA) is more useful for the decision making between clipping and coiling.

  The efficacy of mechanical thrombectomy for acute ischemic stroke due to large vessel occlusion was established in 2015 for early-presenting stroke, and in 2018 for late-presenting stroke. Imaging-based patient selection and the shortened time from onset to reperfusion are essential for improving the outcome of mechanical thrombectomy. The next targets of mechanical thrombectomy include patients with basilar artery occlusions and those with a large ischemic core. Moreover, adjunctive therapies with new thrombolytic or neuroprotective drugs are expected. Furthermore, the establishment of a stroke care system is a pressing issue to increase the use of mechanical thrombectomy in clinical settings.

  In response to the Hanshin-Awaji Great Earthquake, disaster base hospitals, disaster medical assistance teams (DMATs) and the Emergency Medical Information System (EMIS) were established. As a staging care unit built and managed by the DMATs, victims were evacuated by Self-Defense Force airplanes or physician-staffed helicopters to unaffected areas. Although this system ran smoothly after this particular disaster, several associated problems remain unresolved. Several medical relief teams have been dispatched to manage disasters in recent years, thus underscoring the importance of organizing these teams properly and providing appropriate medical support for victims from the acute to the chronic phase.

  Traumatic cervical cord injury may both severely compromise the functionality of the limbs and trunk and cause severe dysfunctions in respiration or urination, which may sometimes result in a fatal condition associated with the vertebral artery injury. Although the ideal treatment should be provided without delay, the appropriate management with or without surgical intervention is not always easily determined in a neurosurgical emergency. Health care providers, including physicians, nurses, and all medical co-workers, must be aware that decision making in a neurosurgical emergency can have a significant influence on the prognosis of patients. Therefore, it is crucial that these caregivers collaborate on the treatment consensus and problems.

  We report on a 39-year-old man who developed spinal cord metastases of malignant gliomas, for whom comprehensive treatment was effective. He presented with headache and nausea, and magnetic resonance imaging (MRI) revealed a tumor lesion of 4 cm in the right cerebellar hemisphere. After undergoing craniotomy, he was diagnosed with glioblastomas (World Health Organization [WHO] grade Ⅳ), and chemo-radiation therapy was thus performed. However, subsequent recurrence led to blindness in his left eye ; therefore, he underwent stereotactic radiotherapy, and almost complete recovery of visual acuity was observed. One year later, the patient developed buttock pain and gait disturbance, and he experienced severe paralysis symptoms in both lower limbs and difficulty walking. Whole spine MRI revealed spinal cord metastases, and surgical biopsy indicated that he had glioblastomas (WHO grade Ⅳ). The patient underwent CyberKnife (3,300 cGy in 5 fractions) as a post-operative treatment, and bevacizumab was administered every 2 weeks. Paralysis symptoms of both lower limbs improved from 2 days after irradiation with CyberKnife, and 2 months later, he was discharged on foot. To the best of our knowledge, this case report is the first to show that comprehensive treatment with CyberKnife is effective for spinal cord metastases of malignant gliomas. However, the standard therapy for spinal cord metastases of malignant gliomas has not been established, and radiotherapy only controls symptoms but does not extend survival time. Therefore, further studies are needed to investigate whether comprehensive treatment with CyberKnife extends survival time for patients with symptomatic spinal cord metastasis.