Neurocritical Care

Find all of the Neurocritical Care posts here.

CNS infection prophylaxis in immunocompromised

Central nervous system (CNS) infections are uncommon amongst the immunocompetent population. A state of immuno-incompetency increases susceptibility of the CNS to infection. CNS infections incur serious burden on the morbidity and mortality of cancer patients

Cardiac dysfunctions in Neurocritical Care

A variety of brain disorders affect cardiac function, causing increased mortality as well as short- and long-term complications

Quantitative EEG - An Introduction

Quantitative Electroencephalography (qEEG) is the digital analysis of the raw EEG data with the application of mathematical and analytical techniques to characterize the EEG signal.

Status Epilepticus: Classification, Clinical Features, and Diagnosis

Classifying the type of status epilepticus is important in determining morbidity and aggressiveness of treatment required. Clinical manifestations vary according to the type of seizure the patient experiences and yet diagnosis is made clinically based on those clinical manifestations. This chapter will help you understand the classification and how to diagnose patient based on clinical features.

Spinal Cord Injury

The traumatic spinal cord injury often results from a gunshot wound (10.4%), accidental trauma to the head, neck, and back region (31.5%), falling (25.3%), and spinal sports injuries (4.3%) while non-traumatic spinal cord injuries can vary. The main purpose of this chapter is to help you understand the difference between complete and incomplete cord transection and different types of spinal injuries.

Refractory Status Epilepticus

When patients fail first-line therapy which is a sufficient dose of benzodiazepines and at least one AED as second-line therapy, irrespective of time this is termed refractory status epilepticus. Primary drugs being used for refractory status epilepticus are Midazolam, Propofol, and Ketamine while other interventions include DBS, surgery, VNS, etc. This chapter focuses on the treatment strategies being involved to treat patients with refractory status epilepticus

Cerebral Blood Flow

During cerebral autoregulation, optimal perfusion pressure is maintained by changes in Cerebrovascular resistance. CBF is kept relatively constant through the change in vessel diameter at the CPP range of 40-140 mmHg. It is controlled by means of myogenic, metabolic, and neurogenic factors, and partial pressure of arterial blood gases (CO2 and O2), cerebral metabolism, and the autonomic nervous system are primary determinants of CBF.

Prophylaxis of Venous Thrombosis in NeurocriticalCare

Risk of DVT in at-risk medical patients without anticoagulant prophylaxis is10–15%. PE occurs in up to 50% of patients with DVT. While giving prophylaxis of venous thrombosis, a physician needs to know about contraindication and should use Neurocritical Care Society Guideline Recommendation.

Seizures prophylaxis in Traumatic Brain Injury

Short term (7-10 days) prophylaxis with ASM is recommended for Severe TBI. Prophylactic administration of Anti-Seizure Medications (ASMs) is used as a measure to decrease the risks of post-traumatic seizures and progression into post-traumatic epilepsy (PTE) and most commonly used are Phenytoin or Levetiracetam.

Determining Brain Death

Permanent, irreversible termination of cerebral and brainstem functions including the ability to regulate respiratory activities. American Academy of Neurology has provided criteria to diagnose brain death but most states and hospitals have their own criteria so make sure to use your local criteria if that is available.

Continuous EEG - Indication and Utilizations

Continuous EEG monitoring device with a video camera for at least 24 hours in a conscious patient reflecting cortical synaptic activity. CEEG is most commonly performed in ICU settings in order to monitor critically ill patients. Neuronal activity depends on the blood supply hence it makes EEG monitoring reliable to check for brain ischemia. Automated displays help to interpret raw EEG effectively. Commonly used techniques for these displays are Color density spectral array and Amplitude-integrated EEG. This chapter will help you understand the concepts of continuous EEG, it’s indications, and utilization in different settings along with the emphasis on the advantages to use this technique.

Seizure prophylaxis in Spontaneous Intracerebral Hemorrhage

Acute seizures are a common complication following spontaneous intracerebral hemorrhage (sICH). The incidence of post ICH seizures rate is estimated to be between 4%-16%. Current guidelines have limited recommendations due to the paucity of data.

Spontaneous Intracerebral Hemorrhage (ICH)

Spontaneous intracerebral hemorrhage is defined as focal bleeding from the blood vessel into parenchyma of the brain in the absence of trauma or surgery. ICH is a medical emergency requiring immediate treatment. Less common than ischemic stroke but is more serious.

Cerebral Venous Thrombosis

Thrombosis of cerebral (brain) veins and sinuses. Relatively rare and frequently unrecognized condition. Potentially severe and fatal condition

Subarachnoid Hemorrhage

Extravasation of blood into the subarachnoid space between the arachnoid membrane and the pia mater. It is a neurological emergency associated with high morbidity and mortality. It can be due to Trauma (most common) or vascular malformation.

Acute Encephalopathy

Change in level of consciousness associated with altered cognition and/or perception appearing over hours/days that is not secondary to prior/developing chronic dementia. Encephalopathy results in acute structural brain changes to non-structural, metabolic, toxic, infection related brain dysfunction

Chronic Subdural Hematoma

Slow extravasation of blood into the subdural space between the dura and arachnoid membranes. Commonly seen neurosurgical condition associated with high morbidity and mortality

Acute Subdural Hematoma

Extravasation of blood into the subdural space between the dura and arachnoid membranes. Most common neurosurgical emergency associated with high morbidity and mortality. A potentially life-threatening condition requiring urgent surgical evacuation for good clinical outcomes

Status Epilepticus - Management, Prognosis, and EEG utilization

Status epilepticus (SE) is defined as β‰₯5 minutes of continuous clinical and/or electrographic seizure activity or recurrent seizure activity without recovery (returning to baseline) between seizures

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