The spectrum of neurologic emergencies in pregnancy extends from life-threatening eclamptic seizures to self-limiting paresthesias. Pregnancy markedly modifies human physiology, creating a unique and challenging physical and laboratory evaluation. In addition, pregnant patients may present with gestational and peripartum conditions resulting directly from pregnancy, but also a portent of future disease as well as exacerbation of pre-existing conditions changed by the patient’s gravid state. All of these issues can be complicated by the “second patient” (the fetus), which requires careful consideration.