Common neurological emergencies
Stroke is the most time-critical neurological emergency. Sudden-onset facial droop, arm weakness, speech difficulty (FAST criteria), or abrupt visual loss, severe headache with neurological deficits, or sudden unexplained confusion require emergency evaluation within hours. Clot-dissolving treatment (thrombolysis) and clot retrieval (thrombectomy) are time-sensitive interventions that reduce disability when administered promptly.
Seizures lasting more than 5 minutes (status epilepticus), repeated seizures without recovery between episodes, and first seizures with injury or breathing difficulty are emergencies requiring immediate hospital care. Thunderclap headache — sudden-onset severe headache reaching maximum intensity within seconds to minutes — may indicate subarachnoid haemorrhage and demands emergency CT brain and lumbar puncture if CT is negative. Acute weakness or numbness affecting one side of the body, sudden difficulty walking or maintaining balance, and acute severe headache with fever and neck stiffness (meningitis) also require emergency evaluation.
- Stroke — sudden facial droop, arm weakness, speech difficulty — emergency
- Status epilepticus — seizure lasting >5 minutes — emergency
- Thunderclap headache — worst-ever headache, sudden onset — emergency
- Acute one-sided weakness or numbness — emergency
- Fever with headache and neck stiffness — meningitis until proven otherwise
Related: Neurologist Kathmandu → · Dr. Jitendra Knowledge Hub → · ICHD-3 Topic →
What to do and where to go
If a neurological emergency is suspected, call emergency services immediately or proceed directly to the nearest hospital emergency department. Do not wait to see if symptoms improve. Time-sensitive treatments for stroke (thrombolysis within 4.5 hours, thrombectomy within 24 hours for appropriate patients) and status epilepticus (IV lorazepam or diazepam) are most effective when administered early.
In Kathmandu, major hospitals with emergency neurological services include Tribhuvan University Teaching Hospital, Nepal Medical College, and National Trauma Centre. For patients who reach Kathmandu Neurology Clinic & Cognitive Center at Durbar Marg, Opposite of Yak & Yeti Hotel with suspected neurological emergency, immediate stabilisation and appropriate hospital referral are arranged. After any emergency, structured follow-up with a neurologist addresses secondary prevention, medication review and recovery planning. Dr. Jitendra Prasad Yadav (NMC 8029) provides post-emergency follow-up at the clinic, Durbar Marg, Opposite of Yak & Yeti Hotel.
- Call emergency services or go to nearest hospital immediately — do not wait
- Time-sensitive stroke treatments most effective within hours of onset
- Major hospitals in Kathmandu with emergency neurological services
- Post-emergency follow-up addresses secondary prevention and recovery