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Consciousness can be defined as the state of awareness of self and one’s relationship with the environment Consciousness consists of two components: wakefulness or arousal and awareness Both components have anatomic substrates that, when affected, can lead to disturbances in consciousness
Acute encephalopathy is an abrupt and pathologic alteration in cognitive function and/or behavior caused by an underlying functional or structural brain disorder A number of synonymous terms exist in the literature, including organic brain syndrome, acute confusional state, delirium, acute toxic-metabolic encephalopathy, cerebral insufficiency, brain failure, ICU syndrome, ICU psychosis. In recent...
Traumatic brain injury (TBI) is a major cause of traumatic death and disability In the US, a brain injury occurs every 7 s and results in death every 5 min ∼52,000 patients die from TBI each year TBI accounts for nearly one-third of all trauma-related deaths Common mechanisms include falls, motor vehicle accidents, and assaults In the US, most TBIs are related to motor vehicle accidents Estimate for...
Acute myelopathy is a broad term used to describe spinal cord dysfunction of sudden, recent onset Diagnostic possibilities are ample, but practicing neurointensivists deal mainly with traumatic and inflammatory myelopathies Main objective in the initial management is to differentiate those patients who could benefit from acute surgical intervention (compressive myelopathies) from those patients...
Ischemic stroke: Focal neurologic deficit referable to the CNS that corresponds to an arterial territory Transient ischemic attack (TIA) Stroke symptoms resolve within <24h, typically within <1h Might be related to transient hypotension in the setting of critical stenosis or could be secondary to a clot/embolus, with subsequent recanalization of obstructed vessel
Intracerebral hemorrhage (ICH) accounts for 10–15% of all strokes 67,000 cases of nontraumatic ICH are reported annually in the US Reported 30-day mortality rates range between 35 and 52%, the highest associated with any kind of stroke Only 20% of survivors are functionally independent at 6 months More common in males, persons >55 years of age, and in certain ethnic groups (Blacks, Japanese)
Intraventricular hemorrhage (IVH) is defined as bleeding within the ventricular system IVH can occur as a primary event or in association with intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), or traumatic brain injury (TBI) “Primary IVH” is a rare occurrence in which hemorrhage is confined only to the ventricular system “Secondary IVH” denotes a hemorrhage that originates from parenchyma...
Subarachnoid hemorrhage (SAH) refers to the extravasation of blood into the spaces surrounding the (brain and spinal cord that contain cerebrospinal fluid
Neurologic injury resulting from global cerebral ischemia secondary to cardiac arrest (CA) continues to be a major clinical problem that requires urgent neurocritical care intervention Estimates of the yearly incidence of sudden CA in the US varies widely from 250,000 to 460,000
Meningitis specifically means presence of inflammation of the meninges Practically, this means that inflammatory cells and inflammatory markers are in the subarachnoid space Inflammation may be infectious (bacterial, viral, fungal), chemical (blood, anesthetics), or idiopathic
Cerebral venous sinus thrombosis (CVST) constitutes ∼1% of all stroke presentations Occurs at any age, but incidence peaks in the neonatal period and in the third decade Estimated annual incidence: adults, three to four cases per million; children or neonates, seven cases per million Female-to-male ratio: 1.5–5 to 1
Epidemiology Neuroleptic malignant syndrome (NMS) is rare, diagnosed annually in 2,000 hospitalized patients in the US Recent studies suggest an incidence of 0.01–0.02% in patients treated with antipsychotic medications Risk factors
Brain tumor is the most common cause of death from intracranial disease, second to stroke ∼18,500 new diagnoses of brain tumor per year in the US in 2005 ∼12,760 deaths from brain tumor per year in the US in 2005 Metastatic brain tumors are twice as prevalent as primary brain tumors in the adult population Overall 5-year survival of all brain tumors is estimated to be 33% The only well-validated risk...
Derived from the Greek words hydro, meaning “water,” and cephalus, meaning “head” First described by Hippocrates, but it remained an intractable condition until the twentieth century, when shunts and other neurosurgical treatment modalities were developed Defined as dilation of cerebral ventricles
Neuromuscular diseases may require ICU care for three primary disease-associated reasons Respiratory muscle weakness Bulbar muscle weakness, leading to failure to protect airway Autonomic dysfunction/instability, leading to hemodynamic compromise from swings in blood pressure, heart rate, or dysrhythmia
A seizure that persists for a sufficient length of time or is repeated frequently enough to produce a fixed and enduring epileptic condition Distinct seizure phenomenon – not simply a prolonged seizure; status epilepticus (SE) represents a reconfiguration of excitatory and inhibitory networks within the brain Historically, experts in the field arbitrarily defined SE as unremitting seizures...
10% of hospital deaths are attributed to pulmonary embolism (PE) In-hospital case-fatality rate of venous thromboembolism (VTE) is ∼12% Pulmonary embolism (PE) 79% of patients who present with PE have evidence of DVT in lower extremities Overall 3-month mortality is ∼15% Most common cause of early death is right ventricular failure Mortality after 30 days is usually caused by underlying disease 18%...
Critical care support and admission to an ICU is a relatively infrequent occurrence during pregnancy and the postpartum period Retrospective analyses of hospital admissions and complication rates indicate that 0.11–1.1% of deliveries are complicated by maternal ICU admission Patient demographics and hospital type clearly vary and affect outcomes differently; therefore, understanding the true risk...
In the US, the Harvard Ad Hoc committee and the Presidents Commission in 1981 defined criteria for brain death in 1968, which were later codified in the Uniform Determination of Death Act (UDDA) in 1981 The UDDA reads: “An individual who has sustained either: (1) irreversible cessation of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including...
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