An 18-year-old female presents with confusion, seizures, and fever. Patient is unable to provide history, but her mother states that she began noticing confusion 2 days ago, and the patient expressed head discomfort yesterday. The patient appears lethargic and does not follow commands, and she is febrile and tachycardic. She has nuchal rigidity and is hyperreflexic with upgoing toes bilaterally. What is the patient's diagnosis? What is the next step in your evaluation and treatment?

Cervical artery dissection can be a difficult diagnosis. Read on for pearls and pitfalls in the ED.

Welcome to this week’s edition of EMin5 by Dr. Anna Pickens.  Today we’ll review a few tips on how to do a rapid neurology exam of the hand, and the great thing is you can complete the whole thing with one swift motion!

Clay brings you managing severe hypertension, guidelines on nonvariceal upper GI bleeding, and AHA stroke guideline updates.

Our wrap-up this week covers febrile seizure, duration of antibiotic therapy for strep throat, fluid bolus before intubation, and the 2019 ACEP policy on acute headaches.

Chuck brings a tough case of cauda equina syndrome in this month's Medical Malpractice Insights.

What should you do with the critically ill patient with meningitis?

A 29-year-old female presents with generalized weakness and vision problems. The weakness is worse at the end of the day, and she has noted double vision. The symptoms worsen with heat. She denies any other neurologic deficits, including paresthesias. What is the likely diagnosis, and what is your next step in evaluation?