Neurologic Complications of Critical Illness

by Wijdicks, Eelco F.M.

• ISBN13: 9780195140798
• ISBN10: 0195140796
• Edition: 2nd
• Format: Hardcover
• Copyright: 2001-12-27
• Publisher: Oxford University Press

Summary

This second edition of the definitive volume on the diagnosis and management of neurologic complications during critical illness has been thoroughly revised and expanded to bring the book up-to-date. Important features include information on neurologic complications in organ transplant recipients, muscle and nerve injury in critical illness, status epilepticus, cerebral edema, multisystem trauma including cervical spine and traumatic brain injury, and prognosis. The second edition includes entirely new chapters on: *Evaluation of coma focused on structural causes *Neurologic complications in the critically ill pregnant patient *Ethical issues and practical problems with withdrawl of life support New material on: *Pathophysiological mechanisms (set off in different type so that these sections can be read separately) *Neuroimaging studies (including the addition of two pages of full color plates) *Electrophysical examples including EEG, evoked potentials, and nerve conduction studies The first edition (published under the titleNeurology of Critical Illnessby F.A. Davis in 1995) was highly praised as a concise, practical volume introducing this new and rapidly-evolving specialty that focuses on the care of patients in general medicine and sugical intensive care units with significant disease of the nervous system, either as a primary event or secondary to involvement of organs outside the nervous system. The book is intended for neurologists, intensivists, anesthesiologists, pulmonologists, neurosurgeons, neurology and ICU nurses, and transplant surgeons.

Table of Contents

Part I General Clinical Neurologic Problems in the Intensive Care Unit
Coma and Other States of Altered Awareness	3	(25)
Definitions of Altered States of Consciousness	3	(2)
Locked-in Syndrome
Hypersomnia
Acute Confusional State
Coma
Persistent Vegetative State
Brain Death
Neuroanatomy and Neuropharmacology of Consciousness	5	(1)
Neurologic Examination of the Acutely Confused Patient	6	(2)
Neurologic Examination of Comatose patients	8	(7)
Brain Herniation Syndromes	15	(1)
Neurologic Examination in Brain Death	16	(2)
Brain Stem Reflexes
Motor Examination
Apnea Test
Neuroimaging in Coma	18	(1)
Special Clinical Situations and Problems	18	(5)
Failure to Awaken after Discontinuation of Sedation
Failure to Awaken after Surgery
Acute Loss of Consciousness in Evolving Critical Illness
Approach to the Acutely Confused and Delirious Patient	23	(1)
Approach to the Comatose Patient	24	(1)
Approach to Brain Death	24	(1)
Conclusions	25	(3)
Neurologic Manifestations of Pharmacologic Agents Commonly Used in the Intensive Care Unit	28	(18)
Principles of Pharmacodynamics and Pharmacokinetics in Critical Illness	28	(3)
Effect of Drugs on Neuromuscular Function	31	(3)
Effect of Drugs on Level of Consciousness	34	(2)
Narcotic Agents
Midazolam
Lorazepam
Propofol
Commonly Used Drugs With Direct Neurotoxic Effects	36	(4)
Acute Steroid Myopathy
Malignant Hyperthermia
Neuroleptic Malignant Syndrome
Lethal (malignant) Catatonia
Serotonin Syndrome
Conclusions	40	(6)
Seizures in the Intensive Care Unit	46	(17)
Generalized Tonic-Clonic Seizures	46	(1)
Drug-Induced and Drug-Withdrawal Seizures	47	(2)
Seizures and Acute Metabolic Derangements	49	(1)
Seizures and Structural Central Nervous System Abnormalities	49	(1)
Convulsive Status Epilepticus	49	(5)
Laboratory Evaluation and Therapeutic Consequences
Medical Complications
Nonconvulsive Status Epilepticus	54	(1)
Management of Seizures and Status Epilepticus	54	(4)
Outcome	58	(1)
Conclusions	58	(5)
Generalized Weakness in the Intensive Care Unit	63	(9)
General Considerations	63	(1)
Disorders of the Spinal Cord	64	(1)
Disorders of Peripheral Nerves	65	(1)
Disorders of the Neuromuscular Junction	65	(1)
Disorders of Skeletal Muscle	66	(2)
Electrodiagnostic Studies	68	(2)
Conclusions	70	(2)
Neurologic Complications of Invasive Procedures in the Intensive Care Unit	72	(21)
General Considerations	73	(2)
Neurotoxicity of Radiologic Contrast Agents
Cholesterol Embolization
Air Embolism
Neurologic Complications Associated With Specific Procedures	75	(10)
Endotracheal Intubation
Internal Jugular Vein Cannulation
Arterial Cannulation
Cardiac Catheterization
Cardioversion
Percutaneous Transluminal Coronary Angioplasty
Visceral Angiography
Intra-aortic Balloon Pump
Ventricular Assist System
Epidural Catheterization and Diagnostic Lumbar Puncture
Miscellaneous Complications
Conclusions	85	(8)
Part II Neurologic Complications in Medical and Surgical Intensive Care Units and Transplantation Units
Neurologic Manifestations of Bacterial Infection and Sepsis	93	(30)
Bacterial Meningitis	93	(4)
Clinical Features
Additional Studies
Treatment
Outcome
Spinal Epidural Abscess	97	(2)
Clinical Features
Additional Studies
Treatment
Infective Endocarditis	99	(9)
Clinical Features
Initial Studies
Management
Infective Aneurysms
Clostridial Syndromes	108	(2)
Botulism
Tetanus
Sepsis	110	(7)
Critical Illness Polyneuropathy
Sepsis-Associated Encephalopathy
Conclusions	117	(6)
Neurologic Complications of Cardiac Arrest	123	(20)
General Considerations in Resuscitation Medicine	123	(2)
Postresuscitation Encephalopathy	125	(12)
Clinical Features
laboratory Investigations
Treatment and Supportive Care	137	(2)
Basic Management
Intracranial Pressure Monitoring
Specific Treatment
Conclusions	139	(4)
Neurologic Manifestations of Acid-Base Derangements, Electrolyte Disorders, and Endocrine Crises	143	(31)
ACID-Base Disorders	143	(4)
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis
Electrolyte Disorders	147	(14)
Hyponatremia
Hypernatremia
Hypokalemia
Hyperkalemia
Hypophosphatemia
Hyperphosphatemia
Hypomagnesemia
Hypermagnesemia
Hypocalcemia
Hypercalcemia
Endocrine Emergencies	161	(7)
Nonketotic Hyperosmolar State
Diabetic Ketoacidotic Coma
Hypoglycemia
Thyroid Storm
Hashimoto's Encephalopathy
Myxedema Coma
Adrenal Crisis
Conclusions	168	(6)
Neurologic Complications of Acute Renal Disease	174	(16)
Uremic Encephalopathy	174	(3)
Clinical Features
Laboratory Tests
Treatment
Dialysis Dysequilibrium syndrome	177	(2)
Clinical Features
Treatment
Hypertensive Encephlopathy	179	(4)
Clinical Features
Neuroimaging
Treatment
Neuromuscular Disorders	183	(2)
Myopathy
Polyneuropathy of Renal Disease
Mononeuropathies
Conclusions	185	(5)
Neurologic Manifestations of Acute Hepatic Failure	190	(17)
General Considerations	190	(1)
Hepatic Encephalopathy	191	(12)
Clinical Features
Pathogenesis
Laboratory Tests
Medical Management
Management of Brain Edema
Surgical Management and Bridging Devices
Conclusions	203	(4)
Neurologic Complications Associated with Disorders of Therombosis and Hemostasis	207	(19)
Disseminated Intravascular Coagulation	208	(3)
Cerebral Venous Thrombosis
Ischemic and Hemorrhagic Strokes
Treatment
Thrombolysis and Anticoagulation	211	(7)
Thrombolysis-Associated Cerebral Hemorrhage
Anticoagulant Therapy
Thrombotic Thrombocytopenic Purpura	218	(3)
Clinical Features
Laboratory Findings and Neuroimaging
Treatment
Conclusions	221	(5)
Neurologic Complications of Acute Vasculitic Syndromes	226	(12)
General Considerations	226	(1)
Polyarteritis Nodosa	227	(4)
Clinical Features
Peripheral Nervous System Involvement
Central Nervous System Involvement
Churg-Strauss Syndrome	231	(2)
Clinical Features
Peripheral Nervous System Involvement
Central Nervous System Involvement
Wegener's Granulomatosis	233	(1)
Clinical Features
Peripheral Nervous System Involvement
Central Nervous System Involvement
Drug-Induced Vasculitis	234	(1)
Conclusions	235	(3)
Neurologic Complications in the Critically Ill Pregnant Patient	238	(10)
Eclampsia	238	(4)
Clinical Features
Neuroimaging
Management
Hellp Syndrome	242	(1)
Clinical Features
Neuroimaging
Management
Amniotic Fluid Embolism	243	(2)
Clinical Features
Management
Neurologic Complications of Tocolytic Agents	245	(1)
Conclusions	245	(3)
Neurologic Complications of Aortic Surgery	248	(15)
Vascular Anatomy of the Spinal Cord	248	(2)
Scope of the Problem	250	(3)
Neurologic Features of Spinal Cord Infarction	253	(1)
Anterior Spinal Artery Syndrome
Brown-Sequard Syndrome
Central Cord Syndrome
Diagnostic Evaluation of Spinal Cord Infarction	254	(3)
Magnetic Resonance Imaging
Monitoring Techniques
Therapeutic Options	257	(1)
Plexopathies	258	(1)
Aortic Dissection	258	(1)
Neurologic Manifestations
Diagnosis and Management
Conclusions	259	(4)
Neurologic Complications of Cardiac Surgery	263	(21)
General Considerations	263	(5)
Ischemic Storke	268	(5)
Predictive Factors
Clinical Features
Neuroimaging
Management
Neuropsychologic Impairment	273	(2)
Retinal Damage	275	(1)
Peripheral Nerve Damage	276	(2)
Conclusions	278	(6)
Neurologic Complications of Acute Environmental Injuries	284	(18)
Thermal Burns	284	(4)
Burn Encephalopathy
Central Nervous System Infections
Peripheral Neuropathies
Smoke Inhalation	288	(2)
Carbon Monoxide
Cyanide
Electrical Burns	290	(1)
Spinal Cord Damage
Peripheral Neuropathy
Central Nervous System Manifestations
Lightning Injury	291	(2)
Clinical Features
Management
Accidental Hypothermia	293	(2)
Clinical Features
Treatment and Outcome
Heat Stroke	295	(1)
Clinical Features
Treatment and Outcome
Near-Drowning	296	(1)
Clinical Features
Management and Outcome
Conclusions	297	(5)
Neurologic Complications of Multisystem Trauma	302	(35)
Clinical Spectrum of Head Injury	303	(1)
Neuroradiologic Findings in Head Injury	304	(6)
Diffuse Axonal Injury
Traumatic Intracerebral Hematomas
Subdural or Epidural Hematoma
General Principles of Management	310	(2)
Management of Increased Intracranial Pressure	312	(3)
Management of Traumatic Intracranial Hematomas	315	(2)
Epidural Hematoma
Subdural Hematoma
Intraparenchymal Hematoma
Management of Traumatic Cerebral Aneurysm	317	(2)
Trauma of Spine and Spinal Cord	319	(7)
Cervical Spine Injuries
Thoracolumbar Spine Injuries
Sacral Fractures
Acute Spinal Cord Injury	326	(1)
Post-Traumatic Neuropathies Associated with Fractures	326	(3)
Brachial Plexopathies
Lumbosacral Plexus Injury
Miscellaneous Isolated Neuropathies Associated with Fractures
Fat Embolism Syndrome	329	(1)
Conclusions	330	(7)
Neurologic Complications of Organ Transplantation	337	(36)
General Considerations in Transplantation	338	(2)
Kidney and Pancreas Transplantation
Heart and Lung Transplantation
Liver Transplantation
Hematopoietic Stem Cell Transplantation
Neurologic Complications in Transplanation	340	(22)
Neurotoxicity of Immunosuppressive Agents
Central Nervous System Infections
Cerebrovascular Complications
Seizures
De Novo Central Nervous System Malignant Lesions
Neuropathies
Neurologic Complications of Graft-Versus-Host Disease	362	(1)
Polymyositis
Myasthenia Gravis
Conclusions	363	(10)
Part III Outcome in Central Nervous System Catastrophes
Outcome of Acute Injury to the Central Nervous System	373	(16)
Description of Outcome Categories After Coma	373	(2)
Outcome in Metabolic Encephalopathies	375	(6)
Postresuscitation (Anoxic-Ischemic) Encephalopathy
Uremic Encephalopathy
Hepatic Encephalopathy
Sepsis-Associated Encephalopathy
Diabetic Comas
Outcome in Stroke	381	(2)
Intracerebral Hematoma
Ischemic Stroke
Outcome in Head Injury	383	(1)
Outcome in Traumatic Spine Injury	384	(2)
Conclusions	386	(3)
Withdrawing Life Support in the Intensive Care Unit: A Neurologist's Perspective	389	(8)
General Considerations	390	(1)
Legal Aspects of Withdrawal of Care	390	(1)
Decisions in Withdrawal of Care	391	(1)
Withdrawal of Care	392	(1)
Withdrawal of Care in Special Neurologic Circumstances	393	(2)
Conclusions	395	(2)
Index	397