This book reviews the common clinical scenarios that might trigger emergent consultation for neurosurgical intervention, with attention to key components of the clinical interview and exam, optimal diagnostic evaluation, indications for and the goals of operative intervention, perioperative considerations, and strategies for complication mitigation. This is not a surgical atlas, but rather, a road map for the journey to the operating room door. The intent is to establish a systematic, evidence-based action plan for the patient presenting in neurologic crisis.