[Essential Diagnostic Tests in Neurological Emergencies]

Neurological emergencies are time-sensitive conditions in which rapid diagnosis and early intervention critically influence survival and functional outcomes. This review summarizes essential diagnostic strategies for neurosurgeons involved in acute care, guided by the principles of Emergency Neurological Life Support (ENLS). Initial management prioritizes stabilization of the airway, breathing, and circulation, followed by focused neurological assessment, with particular attention to pupillary findings and quantitative monitoring such as the Neurological Pupil index. Laboratory evaluation aims to promptly identify reversible systemic causes, including metabolic disturbances and coagulation abnormalities that directly affect treatment decisions in acute ischemic stroke and intracerebral hemorrhage, particularly in patients receiving anticoagulants. Neuroimaging plays a central role; non-contrast computed tomography (CT) remains the first-line modality, while CT angiography, perfusion imaging, and magnetic resonance imaging (MRI) provide complementary information for therapeutic decision-making. Imaging markers of hematoma expansion and etiological evaluation are essential in hemorrhagic stroke. Electroencephalography (EEG) is crucial for detecting nonconvulsive status epilepticus in patients with unexplained persistent impaired consciousness. Integrating clinical, laboratory, and imaging findings while recognizing common diagnostic pitfalls is essential for optimizing early neurocritical care management.