Neurological Emergency Services: A Case for Change to the Model of Care?

Neurological disorders are a common reason for admission to the ER; these conditions, excluding stroke, account for 10–20% of emergency department (ED) attendances [1, 2]. Epilepsy, meningoencephalitis, Guillain-Barre syndrome, subarachnoid hemorrhage, primary and secondary headache and myasthenia gravis, as well as medical decompensation of chronic neurological disorders, such as: multiple sclerosis, dementia, and Parkinson’s disease, may all lead to an emergency hospital admission. An Italian study, the NeuDay Initiative [3], in November 2018 surveyed Italian ERs that have access to neurological consultation; as expected the most common reason for requesting neurological consultations was cerebrovascular diseases (23.6%), followed by headaches (12%), head injuries (8.6%), dizziness (7.7%), transient disturbances of consciousness (7.1%), epileptic seizures (6.6%), delirium or confusional state (2.7%), other mental disorders (2.6%), as well as less frequent pathological conditions such as Guillain-Barre syndrome, meningoencephalitis, and others that would account all together for approximately 12.0% of all accesses.