Neurological disorders

2019 ◽  
pp. 393-430
Author(s):  
Carl Waldmann ◽  
Andrew Rhodes ◽  
Neil Soni ◽  
Jonathan Handy
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Status Epilepticus ◽  
Critical Illness ◽  
Subarachnoid Haemorrhage ◽  
Myasthenia Gravis ◽  
Ischaemic Stroke ◽  
Intracerebral Haemorrhage ◽  
Neurological Disorders ◽  
De Novo

This chapter discusses neurological disorders and includes discussion on delirium, status epilepticus, meningitis and encephalitis, intracerebral haemorrhage, subarachnoid haemorrhage, ischaemic stroke, Guillain–Barré syndrome, myasthenia gravis, intensive care unit-acquired weakness, tetanus, botulism, rehabilitation and critical illness, and hyperthermias. The aim is to provide a summary of the extensive complex neuological pathologies that can present to an intensive care clinician. Where appropriate, descriptions are provided on clinical presentation, epidemiology, diagnosis (including investigations), and management. Of note, some of the conditions covered can arise on the ward or prehospital environments with subsequent requirement for intensive care, but they can also arise de novo on the intensive care unit itself, highlighting the need for intensive care clinicians to maintain a broad knowledge and understanding of their presentation and management.

Neurocritical Care

2015 ◽  
Author(s):  
Terrance T. Kummer ◽  
Allan H Ropper
Keyword(s):  
Intensive Care Unit ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Critical Care ◽  
Intensive Care ◽  
Status Epilepticus ◽  
Intracerebral Hemorrhage ◽  
Myasthenia Gravis ◽  
Intracranial Hypertension ◽  
Cord Injury

Neurologic critical care encompasses the management of many nervous system diseases when they present in the extremes of severity. Core conditions managed in the neuroscience intensive care unit (ICU) include stroke, cerebral hemorrhage, status epilepticus (SE), myasthenia gravis (MG), Guillain-Barré syndrome (GBS), traumatic brain and spinal cord injury, and high-risk postoperative neurosurgical patients. The skills and knowledge base required to care for patients with such conditions, and the life-threatening complications associated with them, are drawn from both traditional neurology and from critical care medicine. This chapter covers specialized monitoring in the neurologic intensive care unit and special conditions such as acute intracranial hypertension, acute ischemic stroke, intracerebral hemorrhage, venous sinus thrombosis, myasthenia gravis, GBS, seizure and status epilepticus, spinal cord injury, and traumatic brain injury. The chapter includes 8 tables and 5 figures. Tables provide common etiologies of acute intracranial hypertension; general prophylactic measures, medical interventions, surgical interventions, and stepwise treatment protocol for acute intracranial hypertension; drugs that can exacerbate weakness in myasthenia gravis, cholinergic drug dosage equivalents and duration of action, and antiseizure medications used in status epilepticus. Figures illustrate the Monro-Kellie Doctrine, intracranial pressure waveform and plateau waves, typical herniation patterns, large stroke with malignant edema, and examples of nontraumatic intracerebral hemorrhage. This chapter contains 114 references.

scholarly journals Acquired neuromuscular weakness In Intensive Care Unit: Review article

2019 ◽  
Vol 6 (12) ◽  
pp. 4664-4671
Author(s):  
Mohamed Hamdy Elghotmy ◽  
Hamdy Elewa ◽  
Mohamed Rabea
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Muscle Strength ◽  
Burn Injury ◽  
De Novo ◽  
Axonal Neuropathy ◽  
Early Mobilization ◽  
Future Research ◽  
Number Of Patients

A substantial number of patients admitted to the ICU because of an acute illness, complicated surgery, severe trauma, or burn injury will develop a de novo form of muscle weakness during the ICU stay that is referred to as “intensive care unit acquired weakness” (ICUAW). This ICUAW evoked by critical illness can be due to axonal neuropathy, primary myopathy, or both. Underlying pathophysiological mechanisms comprise microvascular, electrical, metabolic, and bioenergetic alterations, interacting in a complex way and culminating in loss of muscle strength and/or muscle atrophy. ICUAW is typically symmetrical and affects predominantly proximal limb muscles and respiratory muscles, whereas facial and ocular muscles are often spared. ICUAW is diagnosed in awake and cooperative patients by bedside manual testing of muscle strength and the severity is scored by the Medical Research Council sum score. In cases of atypical clinical presentation or evolution, additional electrophysiological testing may be required for differential diagnosis. The cornerstones of prevention are aggressive treatment of sepsis, early mobilization, preventing hyperglycemia with insulin, and avoiding the use parenteral nutrition during the first week of critical illness. Future research should focus on new preventive and/or therapeutic strategies for this detrimental complication of critical illness and on clarifying how ICUAW contributes to poor longer-term prognosis.

Acute Neuromuscular Disorders in the Pediatric Intensive Care Unit

2019 ◽  
Vol 35 (1) ◽  
pp. 17-24 ◽  
Author(s):  
Dana B. Harrar ◽  
Basil T. Darras ◽  
Partha S. Ghosh
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Critical Illness ◽  
Myasthenia Gravis ◽  
Pediatric Intensive Care Unit ◽  
Neuromuscular Disorders ◽  
Pediatric Intensive Care ◽  
Neuromuscular Disorder ◽  
Respiratory Monitoring

Background: The neuromuscular disorders encountered in the pediatric intensive care unit (PICU) encompass a broad spectrum of pathologies. These include acute disorders (eg, Guillain-Barre syndrome), acute-on-chronic disorders (eg, myasthenia gravis), progressive disorders (eg, muscular dystrophy), and disorders that develop in the PICU (eg, critical illness myopathy/polyneuropathy). Familiarity with the presenting features of these disorders is of paramount importance in facilitating timely diagnosis. Methods: We conducted a retrospective review of the medical records of patients admitted to the PICU or Intermediate Care Program (ICP) at a single tertiary children’s hospital from 2006 to 2017 with an acute or acute-on-chronic neuromuscular disorder. We did not include patients with a known progressive neuromuscular disorder or critical illness myopathy/polyneuropathy. Results: Twenty-four patients were admitted to the PICU/ICP with acute or acute-on-chronic neuromuscular disorders. Diagnosis and indication for ICU/ICP admission were Guillain-Barre syndrome (n = 6; respiratory failure: 3, respiratory monitoring: 2, autonomic instability: 1), myasthenia gravis (n = 5; airway clearance: 3, respiratory failure: 2), acute flaccid myelitis (n = 3; respiratory failure: 2, respiratory monitoring: 1), periodic paralysis (n = 3; intravenous potassium replacement), rhabdomyolysis (n = 3; monitoring for electrolyte derangements), infant botulism (n = 2; respiratory failure), chronic demyelinating polyneuropathy (n = 1; respiratory failure), and congenital myasthenic syndrome (n = 1; apnea). No patients were admitted to the PICU/ICP with a diagnosis of tick paralysis, acute intermittent porphyria, or inflammatory myopathy. Conclusions: Although acute and acute-on-chronic neuromuscular disorders are encountered relatively rarely in the PICU, familiarity with the presenting features of these disorders is important in facilitating timely diagnosis. This, in turn, enables the institution of effective management strategies, thereby avoiding complications associated with diagnostic delays.

Rhabdomyolysis and Toxic Myopathies

2019 ◽  
pp. 670-676
Author(s):  
Justin C. Kao ◽  
Margherita Milone
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Status Epilepticus ◽  
Critical Illness ◽  
Muscle Activity ◽  
Serotonin Syndrome ◽  
Drug Exposure ◽  
Critical Illness Myopathy

Myopathies in patients in the intensive care unit are comparatively rare and often are due to critical illness (rhabdomyolysis, critical illness myopathy). Rhabdomyolysis is commonly a consequence of continuous muscle activity, such as in status epilepticus and serotonin syndrome. Toxic myopathies are caused by drug exposure. Recognition and management of these 2 major myopathies are discussed.

scholarly journals Assessment of atrial fibrillation in emergency department

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Manzo-Silberman ◽  
T Chouihed ◽  
L Fraticelli ◽  
A Peiretti ◽  
C Claustre ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Vitamin K ◽  
De Novo ◽  
Bleeding Event ◽  
Vitamin K Antagonist ◽  
Funding Source ◽  
Private Company

Abstract Introduction Atrial Fibrillation (AF) is the most common arrythmia, especially in older adults. AF represents 1% of emergency department (ED) visits a third of which are de novo or recurrent. While the diagnosis is given quickly by reading the electrocardiogram (ECG), its management both remains complex. European guidelines have been published in 2016. Purpose Our study aimed to investigate guidelines implementation in French ED. Methods Prospective national multicenter study (clinical trials NCT 03836339) and core interpretation of ECG. Consecutive patients admitted in 32 French ED for AF confirmed by ECG were prospectively included. Clinical characteristics at admission were recorded by the physician. The 3-months telephone follow-up was ensured by one operator. Results From 1/10/2018 to 30/11/2018, 1369 patients with AF were included, of whom 295 (21.55%) had a de novo AF. Patients were 80 [65; 87] years old, 51.17% of men, 71.53% self-ruling, 91.53% living at home, 65.42% transported by firemen or by ambulances and 4,07% by a mobile intensive care unit. Twenty-six (8.84%) patients had a history of stroke or transient ischemic stroke and none of them on anticoagulants. CHA2DS2-VASC score was performed in 66.78% of patients and was 0 in 14 (7.11%) patients. HAS-BLED score = 2 [1; 3]. At admission 50.17% of patients received anticoagulants, of whom 49.32% a non-vitamin K antagonist oral anticoagulant, 0.68% Vitamin K antagonists, 50.68% UFH or LMWH. Beta-blockers were administered in 102 (24.01%) patients and amiodarone in 38 (12.89%). Cardiac echography has been performed in 20.34% of patients. Atrial fibrillation was the primary diagnosis in 42.71% of patients. It has been associated to a pneumopathy in 25.17% of patients, a pulmonary embolism in 4.76% and acute alcoholism in 1.36% of them. Precipitating factor was often undetermined. The discharge to the home concerned 18.64% of patients, 26.78% of patients were hospitalized in ED hospitalization unit, 23.05% in cardiology or intensive care unit. At 3 months, 49% of patients were on anticoagulants, of whom 90% on non-vitamin K antagonist oral anticoagulants, 95% of them didn't report any bleeding event and 41.77% of them were able to have a cardiology consultation within three months. Three-months mortality was about 22.09%, and rehospitalization rate about 22.89%. Conclusion It seems to be a reticence to initiate anticoagulation of patients admitted to ED with a de novo AF. It could be explained by both the advanced age of the patients and the lack of an organized access to a systematic cardiology consultation at discharge. Patients with chronic AF are subject to high mortality at 3 months and a significant risk of readmission. The application of the guidelines could be optimized by a better training program and the implementation of a dedicated pathway of care. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Bayer

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