Keywords
Emergency department
Multimodal monitoring
Point-of-care EEG
Neuroimaging
AI-assisted diagnostics
Acute cerebral injury
Clinical assessment
Patient safety
How to Cite
Abstract
Early recognition of silent neurological deterioration in the emergency department remains a complex and high-stakes clinical challenge. Timely detection is limited by atypical symptom presentation, systemic comorbidities, cognitive biases, and workflow constraints, as well as the subtle and dynamic evolution of cerebral injury. Multimodal assessment, integrating clinical examination, point-of-care EEG, structured neuroimaging, AI-assisted interpretation, and systemic physiological monitoring, provides a structured framework to identify patients at risk and guide acute management. While early markers of neurological decline exist, their sensitivity is constrained in the ED, and reliance on conventional scoring systems alone may delay intervention or misclassify evolving deficits. This review synthesizes current evidence on detection and monitoring of early or silent neurological deterioration, emphasizing the role of sequential, tiered evaluation, integration of multimodal data, and standardized escalation pathways. By contextualizing clinical, electrical, imaging, and systemic parameters in real time, clinicians can optimize acute care, reduce missed diagnoses, and preserve critical therapeutic windows for intervention.
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