Neurologic Complications of Critical Illness

About this book

• This fully updated volume brings together the most important neurological manifestations of criticall illness and has remained the only book of it's kind. All major topics are discussed systematically, thoroughly and logically.

Consults in the Intensive Care Unit to evaluate and manage acute neurological clinical problems are usually of considerable complexity and are the most challenging ones. This single authored monograph is the standard reference on neurological complications of critically ill patients and has been the first and only book of its kind. This comprehensive book will assist the neurologist to recognize and treat complex neurological complications in critically ill patients admitted to medical, surgical, trauma, and transplant intensive care units. Every chapter provides a representative selection of the state of the art in the intensive care unit, necessary for an understanding of critical care medicine.

It offers practical advice on how to best deal wtih coma after cardiopulmonary resuscitation, failure to awaken after surgery, delirium, new onset seizures, generalized weakness, acute paraplegia, movement disorders, and many other manifestations of a neurologic emergency. Other topics include neurologic complications after organ transplantation, spinal cord injury after thoracoabdominal surgery, neurologic complications of invasive procedures and devices, complications from cardiac surgery, traumatic brain, spine, and peripheral nerve injury, and environmental injuries such as hypothermia and near drowning. This book also addresses end of life care in the intensive care unit and the responsibilities of the consulting neurologist.

This third edition has been thoroughly updated and expanded with new chapters on viral infectious outbreaks (West Nile and tick-borne encephalitis), intoxication, poisoning, and chemical and biowarfare. The book closes with a new chapter that provides a practical model on how to best approach these complex patients and five common scenarios are discussed. This third edition adds more than 100 new figures, tables and helpful maangement algorithms, and over 500 new references. All major topics are discussed systematically, thoroughly, and logically. This book is a key practical text for neurologists, intensivists, trauma surgeons, transplant surgeons, and trainees, but also is essential for the critical care nursing staff.

Table of Contents

PART 1: GENERAL CLINICAL NEUROLOGICAL PROBLEMS IN THE INTENSIVE CARE UNIT

1: Coma and Other States of Altered Awareness in the Intensive Care Unit
Definitions of Altered States of Consciousness
Neurologic Examination of the Acutely Confused Patient
Neurologic Examination of the Comatose Patient
Neurologic Examination in Brain Death
Conclusions
2: Neurologic Manifestations of Drugs Used for Analgesia and Anesthesia in the Intensive Care Unit
Principles of Pharmacodynamics and Pharmacokinetics in Critical Illness
Effect of Drugs on Neuromuscular Junction
Effect of Drugs on Level of Consciousness
Malignant Hyperthermia
Concusions
3: Seizures in the Intensive Care Unit
Generalized Tonic-Clonic Seizures
Drug-Induced and Drug-Withdrawal Seizures
Seizures and Acute Metabolic Derangements
Convulsive Status Epilepticus
Non-Convulsive Status Epilepticus
Management of Seizures and Status Epilepticus
Conclusions
4: Generalized Weakness in the Intensive Care Unit
General Considerations
Disorders of the Spinal Cord
Disorders of Peripheral Nerves
Disorders of the Neuromuscular Junction
Disorders of Skeletal Muscle
Conclusions

PART II: NEUROLOGICA COMPLICATIONS IN MEDICAL AND SURGICAL INTENSIVE CARE UNITS AND TRANSPLANTATION UNITS

5: Neurologic Complications of Invasive Procedures
General Considerations
Conclusions
6: Neurologic Manifestations of Acute Bacterial Infections
Bacterial Meningitis
Spinal Epidural Abscess
Infective Endocarditis
Clostridial Syndromes
Sepsis
Conclusions
7: Neurological Manifestations of Infectious Outbreaks
West Nile Virus
Tick Borne Encephalitis
Endemic Influenza
Conclusions
8: Neurologic Complications of Cardiac Arrest
General Considerations in Resuscitation Medicine
Postresuscitation Encephalopathy
Supportive Care
Specific Treatment and Therapeutic Hypothermia
Conclusions
9: Neurologic Manifestations of Acid-Base Derangements, Electrolyte Disorders, and Endocrine Crises
Acid-Base Disorders
Electrolyte Disorders
Glucose Control and Monitoring in ICU
Endocrine Emergencies
Conclusions
10: Neurologic Complications of Acute Renal Disease
Uremic Encephalopathy
Dialysis Dysequilibrium
Hypertensive Encephalopathy Syndromes
Neuromuscular Disorders
Conclusions
11: Neurologic Manifestations of Acute Hepatic Failure
General Considerations
Hepatic Encephalopathy
Brain Edema in Fulminant Hepatic Failure
Conclusions
12: Neurologic Complications Associated with Disorders of Thrombosis and Hemostasis
General Considerations
Disseminated Intravascular Coagulation
Thrombolysis and Anticoagulation
Neoplastic Coagulopathies
Thrombotic Thrombocytopenic Purpura
Conclusions
13: Neurologic Complications of Acute Vasculitis Syndromes
General Considerations
Large Vessel Vasculitis
Polyarteritis Nodosa
Churg-Strauss Syndrome
Wegener's Granulomatosis
Drug-Induced Vasculitis
Conclusions
14: Neurologic Complications in the Critically Ill Pregnant Patient
Eclampsia
Hellp Syndrome
Amniotic Fluid Embolism
Neurologic Complications of Tocolytic Agents
Conclusions
15: Neurologic Complications of Cardiac Surgery
Vascular Anatomy of the Spinal Cord
Scope of the Problem
Neurologic Features of Spinal Cord Infarction
Diagnostic Evaluation of Spinal Cord Infarction
Therapeutic Options
Plexopathies
Aortic Dissection
Conclusions
16: Neurologic Complications of Cardiac Surgery
General Considerations
Ischemic Stroke
Neuropsychologic Impairment
Retinal Damage
Peripheral Nerve Damage
Conclusions
17: Neurologic Complications of Acute Environmental Illness
Thermal Burns
Smoke Inhalation
Electrical Burns
Lightning Injury
Accidental Hypothermia
Heat Stroke
Near-Drowning
Conclusions
18: Neurologic Complications of Drug Overdose, Poisoning, and Terrorism
The Presenting Emergency and Principles of Management
Specific Poisonings
Drugs of Abuse
Biological and Chemical Warfare
19: Neurologic Complications of Multisystem Trauma
Clinical Spectrum of Head Injury
Neuroradiologic Findings in Head Injuries
General Principles of Management
Management of Increased Intracranial Pressure
Management of Traumatic Intracranial Hematomas
Management of Traumatic Cerebral Aneurysm
Trauma of Spine and Spinal Cord
Acute Spinal Cord Injury
Post-Traumatic Neuropathies Associated with Fractures
Fat Embolism Syndrome
War Related Injury
Conclusions
20: Neurologic Complications of Organ Transplantation
Surgical Techniques of Transplantation
Neurologic Complications in Transplantation
Neurologic Complications of Graft-Versus-Host Disease
Conclusions

PART III: OUTCOME IN CENTRAL NERVOUS SYSTEM CATASTROPHES

21: Outcome of Acute Injury to the Central Nervous System
Description of Outcome Categories
Outcome in Metabolic Encephalopathies
Outcome in Stroke
Outcome in Central Nervous System Infections
Outcome in Head Injury
Outcome in Traumatic Spine Injury
Conclusions

PART IV: THE CLINICAL PRACTICE OF CONSULTATIVE NEUROLOGY IN THE INTENSIVE CARE UNIT

22: The Neurologist Consulting in the Intensive Care Unit
Preparation and History Taking
Common Requests for Consults in the ICU
The Role of the Neurologist in Family Discussions
12: The Neurologist and End of Life Care in the Intensive Care Unit
General Considerations
Legals Aspects of Withdrawal of Care
Decisions in Withdrawal of Care
Withdrawal of Care
Withdrawal of Care in Special Neurologic Circumstances
Brain Death and Organ Donation
Cardiac Death and Organ Donation
Conclusions

INDEX