Harvard Neurological Emergencies 2025

• Best practices for the workup of common neurological complaints: Headache, Back Pain, Dizziness, Weakness, and Altered Mental Status
• Optimized approaches to the history and the physical exam
• An algorithmic approach to evaluating headaches (what causes you “cannot miss,” what tests to do and when to image in order to find them)
• A practical algorithmic approach to back pain; how to spot the history and examination “red flags” for spinal cord and cauda equina compression. Learn when to image, and what to look for!
• Acute weakness—the evidence-based initial evaluation for uncommon but serious causes
• The modern evidence-based evaluation of dizziness (spoiler alert—physical exam beats imaging!)
• Video clips from actual patients that help you see, “firsthand,” hard-to-describe physical exam findings
• How to do a “meaningful neurologic exam” on a patient when numerous other patients are waiting to be seen: what to do and how to prioritize
• The best workup for subarachnoid hemorrhage: have “reports of the death of the lumbar puncture been greatly exaggerated”?
• The best inpatient workup for stroke, including how to treat it and what testing needs to be done urgently
• Best current evaluation of altered mental status and coma
• How to determine when a coma patient is not recoverable or brain dead
• Reversible cerebral vasoconstriction syndrome (RCVS): more common than you think!
• Early actions for patients with severe TBI

• Optimize the physical exam:
  • How to quickly and accurately diagnose dizziness at the bedside
  • What is the significance of a Babinski sign in patients with back pain?
  • What findings in a headache patient suggest a specific diagnosis?
• Optimize how you order imaging:
  • When to use CT/CTA/CTP, including what to order and how to interpret results
  • When to use MRI, including what to order, when to order, and when NOT to order
  • How do I know which headache patients need neuroimaging, and which test should I order? Which blood tests can help and when to order them?
• How to tell if it is a stroke mimic, and if you’re not sure, how to proceed with treatment
• Functional neurologic disorders—how to distinguish, how to manage, and how to most effectively communicate to patients
• Back pain: when to order imaging, what to order, and how to interpret results
• When and how to use point-of-care ultrasound to diagnose or treat neurologic complaints

• Updates for acute management of spinal cord and cauda equina compression
• Advances in the management of seizures
• State-of-the-art management of cerebral aneurysms and SAH
• Updates in ED and ICU management of TBI
• Management of head injuries
• How to approach pregnant and post-partum women with acute neurological symptoms
• Management of complex headache patients
• Management of coma and delirium
• Updates in anticoagulation reversal for ICH and TBI
• Endovascular stroke treatment: updates, criteria to determine which patients are candidates for it, when to call the interventionalist
• What to do with patients who might have had a TIA (and when to do it)
• Thrombolytics in stroke: updates and criteria to determine who should (and should not) receive this treatment
• What to do when you find a cerebral aneurysm: determining which patients get surgery and who needs follow-up
• Evidence of cauda equina or spinal cord injury: what to do; information needed by spine surgeons; when to call them and criteria to determine who needs surgery
• Updates for intracerebral hemorrhage patients and whether they need blood pressure treatment, anticoagulation reversal, or neurosurgery
• Acute seizures: treatment updates; how to tell if they are nonepileptic seizures; how to manage them in the inpatient (and outpatient) setting; how to choose among all the antiepileptic drugs
• Treating patients with a carotid or vertebral artery dissection
• Patients with minor head injury and concussion: what they need acutely, and what they need in follow-up
• How to use up-to-date evidence to quickly and accurately diagnose dizziness at the bedside
• What to do with patients if you think they have a functional neurologic disorder
• What to do when a patient’s underlying neurologic disorder seems to be getting acutely worse
• What to think about and what to do with patients with acute visual loss

• Modern stroke management: optimizing IV thrombolytics and endovascular therapy using advanced imaging rather than just the clock
• New criteria to identify stroke patients for endovascular therapy
• Updates in anticoagulation reversal for ICH and TBI
• Treating stroke up to 24 hours after onset
• Treating TIA and intracerebral hemorrhage
• Updates in ischemic stroke, arterial dissections, and reversible cerebral vasoconstriction syndrome
• The right tests to order for potential stroke: when to order CTA, CTP, MRI, MRA, and what is the difference between them?
• Determining if it is a stroke or stroke mimic
• How to avoid missing posterior circulation strokes

• How to ensure the best care for elderly patients who have fallen
• Elderly patients with syncope, delirium, or altered mental status: special considerations for care
• Elderly patients with new headache: is it giant cell arteritis?
• How to determine which patients need further workup for a cause of a fall and which need testing for acute injuries
• Gait disturbance in the elderly

• Avoiding misdiagnosis
• Mitigating liability
• Medical errors: how to avoid them
• Guidance to address medical errors when they happen
• We all make mistakes—hear how the course directors process their own!

Every year there is a vast amount of practice-changing literature on diagnosis and treatment of patients with neurological emergencies. This program provides important updates including current approaches to the history, the physical, and early management.

As a new or returning participant, you can rely on this program to ensure you are up to date with the latest information and prepared to:

• Better evaluate high-frequency neurological symptoms and high-risk neurological conditions
• Avoid misdiagnosis
• Quickly identify a neurological emergency and act in the first hours to optimize patient outcomes in the emergency, inpatient, and outpatient settings
• Optimize your use of diagnostics
• Incorporate updates in practice to ensure state-of-the-art management of high-risk neurological conditions

The faculty is assembled from the best clinician-educators at Harvard Medical School, Massachusetts General Hospital (MGH), Beth Israel Deaconess Medical Center (BIDMC), and other leading medical centers.

The program is designed to deliver the highest-quality educational experience:

• Teaching practical, effective clinical reasoning and approaches that enable you to deliver state-of-the-art care
• Presenting video clips from actual patients that help participants see, “firsthand,” hard-to-describe physical exam findings
• Allowing time for participants to interact with faculty and to pose and get answers to your specific questions
• Providing the latest information in an engaging manner and clinically usable context so that you have knowledge that you can “take home” and immediately apply to patient care