Purpose of Review: This article discusses neurologic complications resulting from environmental injuries and the treatment modalities for these conditions. Recent Findings: Recent advances include improved management of altitude sickness. Relatively uncommon conditions, such as keraunoparalysis (lightning-induced paralysis) and high-pressure neurologic syndrome, are areas of ongoing study. Summary: Environmental injuries may be associated with serious neurologic sequelae. This article reviews thermal and electrical injuries as well as injuries related to aviation, altitude, and diving. Recognition of signs and symptoms of such complex injuries and exposures will permit accurate diagnoses and improved outcomes.