This narrative review examines the neurological consequences of wildfire exposure, explores the underlying pathophysiological mechanisms, and discusses how disaster medicine frameworks can mitigate these adverse outcomes.

Wildfires are uncontrolled fires capable of causing extensive environmental destruction and posing significant threats to human health. Globally, wildfires burn an estimated 400 million hectares annually, releasing high levels of toxic particulates and gases. Exposure to wildfire smoke has been linked to a range of cardiovascular and respiratory impairments; however, the neurological effects remain comparatively understudied.

A narrative review was conducted, focusing on studies describing neurological sequelae of wildfire smoke exposure and correlating disaster medicine responses. Literature was identified through PubMed, Scopus, and EMBASE searches, emphasizing epidemiologic, mechanistic, and clinical findings published between 2000 and 2024.

Wildfire smoke contains fine particulate matter (PM_2.5) capable of crossing the blood–brain barrier and contributing to neurological pathology. During major wildfire events, PM_2.5 concentrations can exceed 300 μg/m³—more than 20 times WHO safety thresholds. Epidemiologic data link increased PM_2.5 exposure to stroke hospitalization and dementia risk. Mechanistically, PM_2.5 exposure induces S-nitrosylation–mediated neurotoxicity, promotes IL-8–driven neuroinflammation, and disrupts tight junction proteins critical to blood–brain barrier integrity. Additionally, wildfires can damage electrical infrastructure, releasing lithium and mercury into the atmosphere, leading to neurotoxic effects such as tremors, ataxia, and insomnia. Mental health conditions—including anxiety, depression, and post-traumatic stress disorder (PTSD)—are also prevalent among affected populations.

The neurological consequences of wildfires disproportionately affect vulnerable populations, amplifying existing health disparities. Disaster medicine frameworks—including resource allocation, evacuation planning, clinical management, and long-term recovery—should be adapted to incorporate neurological risk mitigation. Integrating neuroscience perspectives into disaster preparedness is essential to promote more equitable and effective health outcomes in an era of escalating climate-driven wildfires.