Differential Diagnosis for Basic Neurological Emergencies

Single Most Likely Diagnosis

• Stroke: This is the most common neurological emergency, presenting with sudden onset of focal neurological deficits such as weakness, numbness, or speech difficulties. Immediate management includes thrombolysis if eligible.
• Seizure: A sudden, uncontrolled electrical disturbance in the brain, often presenting with convulsions, loss of consciousness, or altered mental status. Management involves stabilizing the patient and administering antiepileptic drugs.

Other Likely Diagnoses

• Meningitis: Inflammation of the protective membranes covering the brain and spinal cord, typically presenting with fever, headache, and stiff neck. Management involves antibiotics and supportive care.
• Encephalitis: Inflammation of the brain tissue, often due to viral infections, presenting with fever, confusion, and altered mental status. Management includes antiviral medications and supportive care.
• Subarachnoid Hemorrhage: Bleeding into the space surrounding the brain, often due to aneurysm rupture, presenting with sudden severe headache. Management involves stabilizing the patient, stopping the bleed, and managing complications.

Do Not Miss Diagnoses

• Status Epilepticus: Prolonged seizure or recurrent seizures without recovery in between, which is life-threatening and requires immediate intervention with benzodiazepines and other antiepileptic drugs.
• Cerebral Venous Sinus Thrombosis: A blood clot in the venous sinuses of the brain, which can present with headache, seizures, and focal neurological deficits. Management involves anticoagulation.
• Spinal Cord Compression: Compression of the spinal cord, often due to trauma, tumor, or infection, presenting with back pain, weakness, and sensory loss. Urgent management involves steroids and possibly surgery to relieve compression.

Rare Diagnoses

• Creutzfeldt-Jakob Disease: A rare, degenerative, fatal brain disorder, presenting with rapid decline in cognitive and motor functions. Management is supportive.
• Hashimoto's Encephalopathy: A rare condition associated with autoimmune thyroiditis, presenting with altered mental status, seizures, and stroke-like symptoms. Management involves corticosteroids.
• Neurosyphilis: Infection of the brain and spinal cord by the syphilis bacterium, presenting in various forms including meningitis, stroke, and dementia. Management involves penicillin.

Each of these diagnoses requires a thorough clinical evaluation, including history, physical examination, and appropriate diagnostic tests such as imaging (CT, MRI) and laboratory tests (blood, CSF analysis), to guide management and further workup.